Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003430786 |
---|---|
Provider Name | Ms. Tanya Marie Hennix |
First Address | Minot, ND 58703-0817 |
Second Address | Minot, ND 58703-0817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2020 |
Last Update Date | 29/05/2020 |