Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 2015009728 | MO |
N | 104100000X | Social Worker | 9362 | KS |
NPI | 1003201740 |
---|---|
Provider Name | Monica Roberts |
First Address | Columbia, MO 65202-3754 |
Second Address | Columbia, MO 65202-3754 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2015 |
Last Update Date | 31/03/2015 |