Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS016760 | PA |
Y | 103TC0700X | Clinical Psychologist | PS016760 | PA |
NPI | 1003047259 |
---|---|
Provider Name | Dr. Sue Ei |
First Address | Bloomsburg, PA 17815-2506 |
Second Address | Bloomsburg, PA 17815-8976 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2009 |
Last Update Date | 08/05/2010 |