Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 0009923449 | CO |
NPI | 1003400227 |
---|---|
Provider Name | Ms. Caroline Honora Stork |
First Address | Palmer Lake, CO 80133-9003 |
Second Address | Palmer Lake, CO 80133-9003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2021 |
Last Update Date | 28/02/2021 |