| NPI | 1689029290 |
|---|---|
| Former Name | AMANDA JO KOEHN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301017379) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2018-05-10 |