Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003083197 |
---|---|
Provider Name | Ms. Elizabeth Lark Baum |
First Address | Williston, ND 58801-5218 |
Second Address | Williston, ND 58801-5218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2008 |
Last Update Date | 17/02/2009 |