NPI | 1356770705 |
---|---|
Former Name | JESSICA COREY DALE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TE1100X Psychologist, Exercise & Sports (Licence: CO 4018) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO 9923251) |
Enumeration Date | 2013-11-06 |
Last Update Date | 2016-11-09 |