| NPI | 1669795761 |
|---|---|
| Other Name | LAURIE FAIRALL-RUETER |
| Entity Type | Organization |
| Authorized Contact | LAURIE FAIRALL-RUETER Licensed Psychologist 904-463-2284 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY 7675) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 36593) |
| 103TC0700X Psychologist, Clinical (Licence: GA PY003739) | |
| Enumeration Date | 2010-03-04 |
| Last Update Date | 2014-04-17 |