The holder whose full name is Wiesert, Tina Suzanne,come from Indianapolis IN,hold the Temp Clin Soc Worker Permit license(NO.99012524A) which status is Superceded.
| Name | Wiesert, Tina Suzanne |
|---|---|
| License Number | 99012524A |
| License Type | Temp Clin Soc Worker Permit |
| License Status | Superceded |
| City | Indianapolis |
| State | IN |