Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 962-132 | WI |
NPI | 1003034216 |
---|---|
Provider Name | Mrs. Nancy A Shirk |
First Address | Franklin, WI 53132-8571 |
Second Address | Plymouth, WI 53073-1801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |