Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 34003989A | IN |
NPI | 1003009572 |
---|---|
Provider Name | Rita Joan Stover-Conwell |
First Address | Chesterfield, IN 46017-1032 |
Second Address | Chesterfield, IN 46017-1032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2007 |
Last Update Date | 19/08/2007 |