Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801063990 | MI |
NPI | 1003102518 |
---|---|
Provider Name | Ms. Sandra Karen Watson |
First Address | Kalamazoo, MI 49048-1567 |
Second Address | Kalamazoo, MI 49048-1567 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2011 |
Last Update Date | 19/09/2014 |