| NPI | 1982976874 |
|---|---|
| Former Name | KATELYN MARIE RUBERT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR L4633) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L4633) |
| Enumeration Date | 2012-02-07 |
| Last Update Date | 2012-02-07 |