Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801089423 | MI |
NPI | 1003007626 |
---|---|
Provider Name | Rachael Anne Hart |
First Address | Kalamazoo, MI 49008-1654 |
Second Address | Kalamazoo, MI 49008-1654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2007 |
Last Update Date | 14/09/2010 |