The holder whose full name is Prock, Kristen Ann,come from South Bend IN,hold the Temp Clin Soc Worker Permit license(NO.99048069A) which status is Superceded.
| Name | Prock, Kristen Ann |
|---|---|
| License Number | 99048069A |
| License Type | Temp Clin Soc Worker Permit |
| License Status | Superceded |
| City | South Bend |
| State | IN |