Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 33006408A | IN |
NPI | 1003153289 |
---|---|
Provider Name | Alia Osborn |
First Address | Fort Wayne, IN 46835-1821 |
Second Address | Fort Wayne, IN 46835-1821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2013 |
Last Update Date | 08/01/2013 |