Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003067380 |
---|---|
Provider Name | Vanessa Ann Legg |
First Address | Hollywood, FL 33024-3723 |
Second Address | Fort Lauderdale, FL 33316-2619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2008 |
Last Update Date | 04/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
012803100 | (05) | FL |