Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003311531 |
---|---|
Provider Name | Taylor Jandrin |
First Address | Sturgeon Bay, WI 54235-2225 |
Second Address | Sturgeon Bay, WI 54235-2225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2018 |
Last Update Date | 27/03/2018 |