Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 11047 | KS |
NPI | 1003396284 |
---|---|
Provider Name | Amanda Erwin |
First Address | Kansas City, KS 66101-2701 |
Second Address | Kansas City, KS 66101-2702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2018 |
Last Update Date | 17/08/2018 |