Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 15351 | LA |
Y | 104100000X | Social Worker | 2021015379 | MO |
NPI | 1992370449 |
---|---|
Provider Name | Nataliyah Donyelle Friar |
First Address | Clinton, MO 64735-8804 |
Second Address | Wentzville, MO 63385-4836 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2021 |
Last Update Date | 26/05/2021 |