| NPI | 1700080686 |
|---|---|
| Former Name | JENNIFER LYNN WISNESKI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY8640) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY 8640) |
| 103T00000X Psychologist (Licence: NY 017546) | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2021-06-14 |