| NPI | 1477833176 |
|---|---|
| Former Name | JACLYN MICHELLE STADT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS017996) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 38202) |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2020-02-18 |