| NPI | 1992335673 |
|---|---|
| Former Name | MALLORY SPRAGUE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 095648) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801117659) | |
| Enumeration Date | 2020-01-22 |
| Last Update Date | 2024-05-28 |