Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker |
NPI | 1003211988 |
---|---|
Provider Name | Samantha Renee Carlson |
First Address | Festus, MO 63028-1952 |
Second Address | Arnold, MO 63010-1012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2014 |
Last Update Date | 22/04/2021 |