Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TP2701X | Group Psychotherapist |
NPI | 1194490029 |
---|---|
Provider Name | Danielle Marie Page |
First Address | Piedmont, MO 63957-1301 |
Second Address | Piedmont, MO 63957-9607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2021 |
Last Update Date | 12/08/2021 |