Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 33929-6 | SD |
NPI | 1083160717 |
---|---|
Provider Name | Dr. Joyce Anderson |
First Address | Watertown, SD 57201 |
Second Address | Watertown, SD 57201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2016 |
Last Update Date | 01/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33929-6 | STATE OF SOUTH DAKOTA (01) | SD |