| NPI | 1699085803 |
|---|---|
| Former Name | CAROLYN DAWN TUDISCO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN 5627) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2010-10-21 |
| Last Update Date | 2015-05-13 |