Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 2520 | CA |
Y | 103T00000X | Psychologist | 2520 | CA |
N | 103TC1900X | Counseling Psychologist | 2520 | CA |
N | 103TE1100X | Exercise & Sports Psychologist | 2520 | CA |
N | 103TF0000X | Family Psychologist | 2520 | CA |
N | 103TM1800X | Intellectual & Developmental Disabilities | 2520 | CA |
N | 103TS0200X | School Psychologist | 2520 | CA |
NPI | 1033326699 |
---|---|
Provider Name | Dr. Rebecca Ann Dodge |
First Address | Sonora, CA 95370-4771 |
Second Address | Sonora, CA 95370-4771 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 13/05/2019 |