| NPI | 1205936465 |
|---|---|
| Former Name | JENNIFER DIANE BUNDRICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA 3152) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 33200) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2008-01-31 |