| NPI | 1831037142 |
|---|---|
| Former Name | JESSICA VAN BROCKLIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WI 261QM2800X) |
| Enumeration Date | 2026-03-25 |
| Last Update Date | 2026-03-25 |