Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 11927 | KS |
NPI | 1003422189 |
---|---|
Provider Name | Jill Washmon |
First Address | Mission, KS 66202-3299 |
Second Address | Olathe, KS 66061-3123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2020 |
Last Update Date | 23/09/2020 |