NPI | 1275118192 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP4946) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WI 1492) |
103TC0700X Psychologist, Clinical (Licence: WI 1492) | |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN LP4946) | |
Enumeration Date | 2021-03-11 |
Last Update Date | 2021-03-11 |