NPI | 1740720853 |
---|---|
Former Name | KAYLEE E BURNHAM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AL 2118) |
Additional Taxonomies | 103TH0100X Psychologist, Health Service |
Enumeration Date | 2017-03-08 |
Last Update Date | 2020-11-09 |