NPI | 1104966183 |
---|---|
Entity Type | Organization |
Authorized Contact | JACQUELINE DAWN BOCK Owner 907-335-4466 |
Organization Subpart ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AK 561) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AK 561) |
Enumeration Date | 2007-02-07 |
Last Update Date | 2020-08-22 |