Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003284142 |
---|---|
Provider Name | Yvonne Hertich |
First Address | O Fallon, IL 62269-1120 |
Second Address | Saint Louis, MO 63139-2379 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2015 |
Last Update Date | 19/09/2018 |