Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY8263 | FL |
Y | 103TC0700X | Clinical Psychologist | PY8263 | FL |
NPI | 1003185372 |
---|---|
Provider Name | Dr. Jennifer A Broderick |
First Address | Frisco, TX 75035-8807 |
Second Address | Frisco, TX 75035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2011 |
Last Update Date | 07/10/2015 |