Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 6801096780 | MI |
NPI | 1003394990 |
---|---|
Provider Name | Kristen Whiston |
First Address | Utica, MI 48317-5802 |
Second Address | Clarkston, MI 48346-3149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2018 |
Last Update Date | 01/08/2018 |