Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301014036 | MI |
NPI | 1033418082 |
---|---|
Provider Name | Dawn Marie Burch |
First Address | Pontiac, MI 48341-1601 |
Second Address | Pontiac, MI 48341-1601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2011 |
Last Update Date | 21/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1883825 | (05) | MI |