Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 09923138 | CO |
NPI | 1003241555 |
---|---|
Provider Name | Nicole Renee Conklin |
First Address | Tacoma, WA 98431-0001 |
Second Address | Tacoma, WA 98431-6806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2013 |
Last Update Date | 25/02/2020 |