Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 538 | SD |
N | 103TC0700X | Clinical Psychologist | 538 | SD |
Y | 103TC1900X | Counseling Psychologist | 538 | SD |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 538 | SD |
NPI | 1023485646 |
---|---|
Provider Name | Dr. Emilia Sue Flint |
First Address | Spearfish, SD 57783-2700 |
Second Address | Spearfish, SD 57783-2700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2015 |
Last Update Date | 30/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2010722 | (05) | SD |