Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 9007 | FL |
NPI | 1992932578 |
---|---|
Provider Name | Kimberly Ann Wagner-Rohrs |
First Address | St Petersburg, FL 33704-2025 |
Second Address | St Petersburg, FL 33704-2025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2009 |
Last Update Date | 23/11/2009 |