Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 4567 | MT |
Y | 1041C0700X | Clinical Social Worker | 749 | WY |
NPI | 1003052531 |
---|---|
Provider Name | Kimberly Ann Preletz |
First Address | Encampment, WY 82325-0471 |
Second Address | Lander, WY 82520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2009 |
Last Update Date | 07/11/2019 |