Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY 12937 | CA |
N | 103TC0700X | Clinical Psychologist | PSY 12937 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY 12937 | CA |
NPI | 1114974458 |
---|---|
Provider Name | Dr. Jeanne B. Haislett |
First Address | Seal Beach, CA 90740-7640 |
Second Address | Tustin, CA 92780-3038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2006 |
Last Update Date | 08/07/2007 |