Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2012013129 | MO |
NPI | 1003229790 |
---|---|
Provider Name | Jillian Salanski |
First Address | Lees Summit, MO 64086-5544 |
Second Address | Lees Summit, MO 64086-5544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2014 |
Last Update Date | 10/06/2014 |