| NPI | 1376803213 |
|---|---|
| Former Name | JESSICA L. MACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NE 849) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NE 849) |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2019-11-12 |