Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LCSW-716 | WY |
NPI | 1003265521 |
---|---|
Provider Name | Jean Clawson |
First Address | Jackson, WY 83001-4180 |
Second Address | Jackson, WY 83001-9296 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2016 |
Last Update Date | 06/06/2016 |