Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1073846218 |
---|---|
Provider Name | Dr. Melissa Lee Tester |
First Address | Palo Alto, CA 94304-2300 |
Second Address | Palo Alto, CA 94304-2300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2009 |
Last Update Date | 04/09/2009 |