| NPI | 1104013689 |
|---|---|
| Former Name | TAMMY ANNE MANDERNACH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MO 2009010486) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 2009010486) |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2020-06-30 |