Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | LP0611 | KS |
Y | 103T00000X | Psychologist | LP0611 | KS |
NPI | 1013911627 |
---|---|
Provider Name | Dr. Judith Corkum |
First Address | Topeka, KS 66606-1446 |
Second Address | Topeka, KS 66606-1446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2005 |
Last Update Date | 08/07/2007 |