NPI | 1902271521 |
---|---|
Former Name | ALICIA MARIE SWALLEY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: SD 586) |
Additional Taxonomies | 103T00000X Psychologist (Licence: MN 5946) |
Enumeration Date | 2015-12-08 |
Last Update Date | 2025-05-27 |