| NPI | 1083921563 |
|---|---|
| Former Name | SARAH JANICE LIETZOW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6301015705) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2010-09-07 |
| Last Update Date | 2014-03-13 |