Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003361692 |
---|---|
Provider Name | Harrison Bodrie |
First Address | Kalamazoo, MI 49007-5221 |
Second Address | Kalamazoo, MI 49007-5221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2016 |
Last Update Date | 24/08/2016 |