Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003229857 |
---|---|
Provider Name | Sarah Soltis |
First Address | Beaver Dam, WI 53916-9117 |
Second Address | Beaver Dam, WI 53916-9117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2014 |
Last Update Date | 10/06/2014 |