Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | I8314 | OH |
NPI | 1003029968 |
---|---|
Provider Name | Jacqueline Carr |
First Address | Defiance, OH 43512-2123 |
Second Address | Defiance, OH 43512-2123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 16/03/2016 |