| NPI | 1124594031 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: AZ SLP10549) | 
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: LA 7519) | 
| Enumeration Date | 2018-10-17 | 
| Last Update Date | 2018-10-17 |