Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | T18040 | IA |
NPI | 1003396250 |
---|---|
Provider Name | Megan Marie Ohlendorf |
First Address | Sioux City, IA 51101-1324 |
Second Address | Sioux City, IA 51101-1324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2018 |
Last Update Date | 17/08/2018 |