Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 3786-120 | WI |
NPI | 1003163627 |
---|---|
Provider Name | Mr. Robert H. Alm |
First Address | Waukesha, WI 53186-1430 |
Second Address | Waukesha, WI 53186-1430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2012 |
Last Update Date | 14/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3786-120 | SOCIAL WORK CERTIFICATION (01) | WI |