Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | LMSW-33926 | ID |
Y | 1041C0700X | Clinical Social Worker | L8043 | OR |
NPI | 1003294836 |
---|---|
Provider Name | Dani Walker-Novi |
First Address | Bend, OR 97701-7752 |
Second Address | Bend, OR 97703-1947 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2015 |
Last Update Date | 24/04/2019 |