Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 4882-226 | WI |
NPI | 1003408501 |
---|---|
Provider Name | Anderson Mcgregor |
First Address | Wausau, WI 54401-4162 |
Second Address | Wausau, WI 54401-4162 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2021 |
Last Update Date | 05/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4882-226 | STATE LICENSE (01) | WI |