| NPI | 1972994663 |
|---|---|
| Former Name | STACEY RAE WOOD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L6650) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2015-02-17 |
| Last Update Date | 2020-07-20 |