Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 390160 | WI |
NPI | 1073123782 |
---|---|
Provider Name | Candice Truesdell Nokes |
First Address | Cedarburg, WI 53012-1351 |
Second Address | Cedarburg, WI 53012-1351 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2020 |
Last Update Date | 06/08/2020 |