NPI | 1275604720 |
---|---|
Former Name | KATHLEEN KILEY WADE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 3820) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA 20921) |
103TS0200X Psychologist, School | |
Enumeration Date | 2006-11-13 |
Last Update Date | 2010-09-01 |