ANNE MARIE FORMAN - Social Worker License in Wisconsin | # 149003275

ANNE MARIE FORMAN

Business Entity

INACTIVE

License Type

Social Worker

Description

LICENSED CLINICAL SOCIAL WORKER

License Number

149003275

License Status

INACTIVE

Business

N

First Name

ANNE MARIE

Last Name

FORMAN

Business Name

ANNE MARIE FORMAN

Original Issue Date

03/29/1991

Effective Date

11/14/2003

Expiration Date

11/30/2003

State

WI

Specialty/Qualifier

MASTERS

Ever Disciplined

N

LastModifiedDate

12/16/2005