| NPI | 1770720278 |
|---|---|
| Former Name | JODY SORENSON THEIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO 2375) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 64846) |
| 103TS0200X Psychologist, School (Licence: TX 33348) | |
| 103TS0200X Psychologist, School (Licence: CO 0334000) | |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2009-01-21 |