Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 772 | CO |
NPI | 1003017203 |
---|---|
Provider Name | Rene Guerette |
First Address | Lakewood, CO 80226-3413 |
Second Address | Lakewood, CO 80226-3413 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 08/07/2007 |