NPI | 1891030557 |
---|---|
Former Name | KIMBERLY JUNE NYLEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IA 079232) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ID PSY - 202622) |
103TC0700X Psychologist, Clinical (Licence: IL 071008632) | |
Enumeration Date | 2012-12-06 |
Last Update Date | 2015-10-15 |