Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 1097 | LA |
NPI | 1104068170 |
---|---|
Provider Name | Dr. Annie Wingate Spell |
First Address | Lafayette, LA 70508-5744 |
Second Address | Lafayette, LA 70508-5744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2009 |
Last Update Date | 09/07/2009 |