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Individual
MARY BETH NIKLAS
Active
Individual
MARY BETH NIKLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
1528
KY
104100000X
Social Worker
Primary
I0005305
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000106853
ANTHEM PROVIDER NUMBER
OH
Enumeration date
01/14/2007
Last updated
07/08/2007
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