Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003448382 |
---|---|
Provider Name | Jenna Bronson |
First Address | Des Moines, IA 50314-1916 |
Second Address | Des Moines, IA 50314-1916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2020 |
Last Update Date | 05/02/2020 |