Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 19293 | MN |
NPI | 1003120395 |
---|---|
Provider Name | Iva Joan Stauffer |
First Address | Minneapolis, MN 55413-2700 |
Second Address | Golden Valley, MN 55422-4463 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2010 |
Last Update Date | 29/07/2010 |