Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 2588 | ND |
NPI | 1003825837 |
---|---|
Provider Name | Gloria Jean Kern |
First Address | West Fargo, ND 58078-4337 |
Second Address | Fargo, ND 58102-2417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 08/07/2007 |