| NPI | 1063476687 |
|---|---|
| Former Name | JANE HEESEN DIETRICH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY28448) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS007834L) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2017-01-10 |