Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 077231 | NY |
Y | 1041C0700X | Clinical Social Worker | 4445-C | AR |
NPI | 1003117227 |
---|---|
Provider Name | Mrs. Dana A Ilie-Stout |
First Address | Springdale, AR 72762-6683 |
Second Address | Springdale, AR 72762-6683 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2010 |
Last Update Date | 13/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
077231 | LCSW (01) | NY |