| NPI | 1134537863 |
|---|---|
| Former Name | JESSICA LYN MALMBERG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CO PSY.0004120) |
| Enumeration Date | 2014-07-25 |
| Last Update Date | 2019-09-12 |