Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003226200 |
---|---|
Provider Name | Jennifer Foutch |
First Address | St Petersburg, FL 33701-4634 |
Second Address | St Petersburg, FL 33701-4634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2014 |
Last Update Date | 28/04/2014 |