NPI | 1194269837 |
---|---|
Former Name | JENNA PETERSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.009758) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN LP6083) |
Enumeration Date | 2016-12-15 |
Last Update Date | 2024-06-11 |