NPI | 1598125114 |
---|---|
Former Name | JANELLE MENTRIKOSKI |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WV 1291) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MO 2016032355) |
Enumeration Date | 2016-02-24 |
Last Update Date | 2025-01-07 |