Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 2652-057 | WI |
N | 103T00000X | Psychologist | 2652-057 | WI |
Y | 103G00000X | Clinical Psychologist | 2652-057 | WI |
Y | 103TC0700X | Clinical Psychologist | 2652-057 | WI |
NPI | 1003046210 |
---|---|
Provider Name | Jeana L. Magyar-Moe |
First Address | Stevens Point, WI 54481-3566 |
Second Address | Stevens Point, WI 54481-3566 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2009 |
Last Update Date | 03/02/2020 |