Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 0036 | KY |
NPI | 1073724100 |
---|---|
Provider Name | Joan Leslie Clagett |
First Address | Elizabethtown, KY 42701-2950 |
Second Address | Elizabethtown, KY 42701-2950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 08/07/2007 |