Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XE0001X | Environmental Modification | 2014022520 | MO |
NPI | 1790173755 |
---|---|
Provider Name | Maria Lindbergh |
First Address | Kansas City, MO 64164-1219 |
Second Address | Kansas City, MO 64164 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2014 |
Last Update Date | 20/08/2018 |