Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 289712 | NM |
NPI | 1073735064 |
---|---|
Provider Name | Jane Dickinson |
First Address | Santa Fe, NM 87501-0468 |
Second Address | Santa Fe, NM 87501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09288082 | (05) | NM |