Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003054891 |
---|---|
Provider Name | Mrs. Rebecca May Clinton |
First Address | Colorado Springs, CO 80922-2106 |
Second Address | Colorado Springs, CO 80922-2106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2009 |
Last Update Date | 24/05/2016 |