Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | SW010641L | PA |
NPI | 1003004458 |
---|---|
Provider Name | Courtney Anne Kriley |
First Address | State College, PA 16801-2776 |
Second Address | State College, PA 16801-2776 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2007 |
Last Update Date | 11/10/2007 |