Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 11949 | KS |
NPI | 1003415191 |
---|---|
Provider Name | Angela Testa |
First Address | Leavenworth, KS 66048-4108 |
Second Address | Leavenworth, KS 66048-4108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2020 |
Last Update Date | 20/10/2020 |