| NPI | 1689492175 |
|---|---|
| Former Name | SHANNON IVY REID |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: IN 20043698A) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20043698A) |
| 103TH0100X Psychologist, Health Service (Licence: IN 20043698B) | |
| Enumeration Date | 2024-10-02 |
| Last Update Date | 2024-10-30 |