NPI | 1366814758 |
---|---|
Former Name | SUSAN SKEPPSTROM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071009536) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178009626) |
Enumeration Date | 2015-10-23 |
Last Update Date | 2017-04-18 |