Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 00598 | IA |
Y | 103TC0700X | Clinical Psychologist | 00598 | IA |
N | 103TH0004X | Health Psychologist | 598 | IA |
NPI | 1528233673 |
---|---|
Provider Name | Dr. Sally Quincent Oakes Edman |
First Address | Orange City, IA 52101 |
Second Address | Orange City, IA 52101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 29/04/2008 |