| NPI | 1821239880 |
|---|---|
| Former Name | JACLYN MARIE WADDEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 82666) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME 121294) |
| Enumeration Date | 2009-03-20 |
| Last Update Date | 2025-04-07 |