Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PS007053L | PA |
NPI | 1063874279 |
---|---|
Provider Name | Ilsa Loetzbeier |
First Address | Allentown, PA 18103-9610 |
Second Address | Allentown, PA 18103-9610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2016 |
Last Update Date | 26/03/2016 |