Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1104298579 |
---|---|
Provider Name | Dr. Mary Sichi |
First Address | Eugene, OR 97401-2439 |
Second Address | Corvallis, OR 97333-1783 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2015 |
Last Update Date | 12/07/2021 |