Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY23333 | CA |
N | 103TC0700X | Clinical Psychologist | PSY23333 | CA |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY23333 | CA |
NPI | 1114041423 |
---|---|
Provider Name | Jessie Rose Lowell |
First Address | San Dimas, CA 91773-1223 |
Second Address | San Dimas, CA 91773-1223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 22/04/2019 |