Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 69019-1 | SD |
NPI | 1013464676 |
---|---|
Provider Name | Joel Sonnichsen |
First Address | Sioux Falls, SD 57105-3837 |
Second Address | Sioux Falls, SD 57105-5815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2016 |
Last Update Date | 01/09/2016 |