Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 1013 | NE |
N | 103T00000X | Psychologist | 1013 | NE |
Y | 102L00000X | Psychologist | 107094 | IA |
Y | 103T00000X | Psychologist | 107094 | IA |
N | 103TH0100X | Health Service | 107513 | IA |
N | 103TS0200X | School Psychologist | 2017003144 | NE |
NPI | 1013416874 |
---|---|
Provider Name | Dr. Annie L Stachowitz |
First Address | Sioux City, IA 51105-1417 |
Second Address | Sioux City, IA 51105-1417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2018 |
Last Update Date | 08/03/2021 |