Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 34005502A | IN |
NPI | 1003039553 |
---|---|
Provider Name | Megan White |
First Address | Bloomington, IN 47403-2353 |
Second Address | Seymour, IN 47274-3391 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 26/01/2015 |