Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 2005025788 | MO |
NPI | 1003071879 |
---|---|
Provider Name | Mrs. Miriam E Green |
First Address | Springfield, MO 65802-3429 |
Second Address | Springfield, MO 65802-3429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2008 |
Last Update Date | 22/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
497463802 | (05) | MO |