Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1134645724 |
---|---|
Provider Name | Kelsie-Marie Offenwanger |
First Address | Wauconda, IL 60084-1784 |
Second Address | Marshfield, WI 54449-5703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2017 |
Last Update Date | 31/03/2021 |