Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 4589 | SC |
NPI | 1073850004 |
---|---|
Provider Name | Dr. Alan C Eggert |
First Address | Roebuck, SC 29376-3367 |
Second Address | Roebuck, SC 29376-3367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2013 |
Last Update Date | 10/01/2013 |