Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6301011637 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301011637 | MI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6301011637 | MI |
N | 103G00000X | Clinical Psychologist | 63010111637 | MI |
N | 103TC0700X | Clinical Psychologist | 63010111637 | MI |
NPI | 1235115171 |
---|---|
Provider Name | Dr. Rudolph Clinton Hatfield |
First Address | Saginaw, MI 48602-4316 |
Second Address | Saginaw, MI 48602-4316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 03/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q22039 | (02) | MI |