Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 83696 | DE |
NPI | 1053760629 |
---|---|
Provider Name | Erin Johnson |
First Address | Lewes, DE 19958-1735 |
Second Address | Lewes, DE 19958-1735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2016 |
Last Update Date | 06/06/2016 |