Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 7236 | KS |
Y | 1041C0700X | Clinical Social Worker | 60328 | TX |
N | 1041C0700X | Clinical Social Worker | 7236 | KS |
NPI | 1003063678 |
---|---|
Provider Name | Lisa Katherine Degraff |
First Address | Austin, TX 78735-6757 |
Second Address | Austin, TX 78735-6757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2008 |
Last Update Date | 25/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1841281805 | (05) | KS |