NPI | 1457810871 |
---|---|
Former Name | AMANDA MARY BODE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301016482) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6361999795) |
Enumeration Date | 2019-03-15 |
Last Update Date | 2025-03-26 |