NPI | 1104171511 |
---|---|
Former Name | JAMIE LEE KREMSREITER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: IA 073905) |
Additional Taxonomies | 103T00000X Psychologist (Licence: NE 4300) |
Enumeration Date | 2012-07-23 |
Last Update Date | 2019-05-30 |