Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | LMSW11993 | KS |
NPI | 1003400151 |
---|---|
Provider Name | Riley Koster |
First Address | Overland Park, KS 66209-2825 |
Second Address | Overland Park, KS 66212-4628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2021 |
Last Update Date | 01/03/2021 |