Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 39052-6 | SD |
NPI | 1063860609 |
---|---|
Provider Name | Cora Alley |
First Address | Sturgis, SD 57785-1869 |
Second Address | Sturgis, SD 57785-1869 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2016 |
Last Update Date | 24/05/2016 |