Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 6301003018 | MI |
N | 103TC0700X | Clinical Psychologist | 6301003018 | MI |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301003018 | MI |
NPI | 1033305206 |
---|---|
Provider Name | Dr. Joy Wolfe Ensor |
First Address | Ann Arbor, MI 48103-8943 |
Second Address | Ann Arbor, MI 48103-8943 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2007 |
Last Update Date | 19/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
68-0-H1-1769-0 | BLUE CROSS BLUE SHIELD OF MICHIGAN (01) | MI |