Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6292-C | NV |
NPI | 1003169905 |
---|---|
Provider Name | Michelle V Sandoval |
First Address | Elko, NV 89801-8319 |
Second Address | Elko, NV 89801-8319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2012 |
Last Update Date | 16/09/2021 |