Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 160071453 | CA |
NPI | 1003441320 |
---|---|
Provider Name | Christine Simone Gunderson |
First Address | Dpo, AA 34011-0042 |
Second Address | Nassau, NEW PROVIDENCE 00000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2020 |
Last Update Date | 06/03/2020 |