NPI | 1962824706 |
---|---|
Former Name | JENNIFER JEAN MONTGOMERY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 63059) |
Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801093215) |
Enumeration Date | 2014-01-14 |
Last Update Date | 2016-12-12 |