Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 2440 | WI |
Y | 103T00000X | Psychologist | 2440 | WI |
NPI | 1013989243 |
---|---|
Provider Name | Elizabeth Ryann Watson-Stites |
First Address | Eugene, OR 97403-5254 |
Second Address | Eugene, OR 97403-5254 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 03/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
39143500 | (05) | WI |
Q00899 | (02) |