NPI | 1235200791 |
---|---|
Former Name | DIANE KAY SANDRUM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN LP1489) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN LP1489) |
103TF0200X Psychologist, Forensic (Licence: MN LP1489) | |
103TH0004X Psychologist, Health (Licence: MN LP1489) | |
Enumeration Date | 2006-11-13 |
Last Update Date | 2024-10-16 |