NPI | 1164942314 |
---|---|
Entity Type | Organization |
Authorized Contact | BOBBI S KOUSOULOS Practice Administrator 907-357-4543 |
Organization Subpart ? | No |
Primary Taxonomy | 208000000X Pediatrics |
Additional Taxonomies | 101YP2500X Counselor, Professional |
103G00000X Clinical Neuropsychologist | |
235Z00000X Speech-Language Pathologist, | |
Enumeration Date | 2017-06-20 |
Last Update Date | 2017-06-20 |