Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 2668 | ND |
N | 1041S0200X | School Social Worker | 2668 | ND |
NPI | 1003122987 |
---|---|
Provider Name | Mrs. Brenda Jo Erie |
First Address | Dickinson, ND 58601-3462 |
Second Address | Dickinson, ND 58601-2647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2010 |
Last Update Date | 22/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4560002242 | (05) | ND |