| 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 |