| NPI | 1831707264 |
|---|---|
| Former Name | JESSICA A BRODZELLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 402057) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 8221-125) |
| Enumeration Date | 2020-07-22 |
| Last Update Date | 2022-07-20 |