Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1073997284 |
---|---|
Provider Name | Jessica Lynn Wafer |
First Address | Ridge, NY 11961-1706 |
Second Address | Huntington, NY 11743-4550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2015 |
Last Update Date | 09/05/2017 |