Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | P008136 | NC |
Y | 1041C0700X | Clinical Social Worker | 26166 | MN |
NPI | 1003255472 |
---|---|
Provider Name | Sarah Nicole Olson Venning |
First Address | Maple Grove, MN 55369-4730 |
Second Address | Maple Grove, MN 55369-4730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2013 |
Last Update Date | 02/05/2017 |