| NPI | 1104456383 |
|---|---|
| Former Name | AMANDA I TATLOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 170300000X Genetic Counselor, MS (Licence: MA GC056) |
| Additional Taxonomies | 171400000X Health & Wellness Coach (Licence: A-3628849) |
| Enumeration Date | 2020-01-16 |
| Last Update Date | 2023-05-29 |