Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003219130 |
---|---|
Provider Name | Helen Waller |
First Address | Orlando, FL 32826-2288 |
Second Address | Orlando, FL 32826 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2014 |
Last Update Date | 03/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1690461740 | (05) | FL |