TRACEY K TAKETA FUGAZZI Social Worker License verification

Business Entity

INACTIVE

License Type

Social Worker

Description

LICENSED CLINICAL SOCIAL WORKER

License Number

149010077

License Status

INACTIVE

Business

First Name

TRACEY

Middle

Last Name

TAKETA FUGAZZI

Business Name

TRACEY K TAKETA FUGAZZI

Original Issue Date

05/09/2002

Effective Date

12/10/2003

Expiration Date

11/30/2005

City

HENDERSON

State

Zip

89012

County

CLARK

Specialty/Qualifier

MASTERS

Ever Disciplined

LastModifiedDate

12/16/2005