Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | ||
Y | 1041C0700X | Clinical Social Worker | L4131 | OR |
NPI | 1003011099 |
---|---|
Provider Name | Sonja Anne Fry |
First Address | Eugene, OR 97401-2773 |
Second Address | Eugene, OR 97401-2773 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 13/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L4131 | VA EMPLOYEE (01) | OR |