Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 686 | WA |
NPI | 1073748950 |
---|---|
Provider Name | Dr. Nancy Sasse Sasser |
First Address | Moscow, ID 83843-9199 |
Second Address | Moscow, ID 83843-9199 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2009 |
Last Update Date | 21/05/2009 |