Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301014160 | MI |
Y | 103T00000X | Psychologist | 6301014160 | MI |
NPI | 1013237346 |
---|---|
Provider Name | Jennifer L Patterson |
First Address | Livonia, MI 48150-1805 |
Second Address | Livonia, MI 48150-1805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2010 |
Last Update Date | 09/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
750910681 | BCBS (01) | MI |