Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3017 | AZ |
Y | 103T00000X | Psychologist | 3017 | AZ |
NPI | 1003804451 |
---|---|
Provider Name | Dr. Jacquelyn St. Germaine |
First Address | Tucson, AZ 85705 |
Second Address | Tucson, AZ 85705-3985 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 08/07/2007 |