| NPI | 1518346261 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY LEE HIETPAS Owner 715-937-8819 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WI 72200-1519) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2015-06-10 |