Individual
ETHAN R KENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSCSW, LCSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497186753
—
MO
Enumeration date
12/11/2013
Last updated
04/18/2018
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