| NPI | 1013161223 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANNINE B. MIELKE Owner 904-607-2079 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY6839) |
| Enumeration Date | 2008-11-14 |
| Last Update Date | 2009-08-17 |