| NPI | 1376862631 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 24415) | 
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MA 5687) | 
| Enumeration Date | 2010-05-26 | 
| Last Update Date | 2019-01-28 |