Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 34006987A | IN |
NPI | 1003229154 |
---|---|
Provider Name | Greta Compton |
First Address | Indianapolis, IN 46204-1020 |
Second Address | Indianapolis, IN 46204-1020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2014 |
Last Update Date | 06/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201160650A | (05) | IN |