| NPI | 1104063122 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202006122) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 018747) |
| Enumeration Date | 2009-01-13 |
| Last Update Date | 2010-09-15 |