Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 6301005541 | MI |
N | 104100000X | Social Worker | 6801065016 | MI |
NPI | 1164666145 |
---|---|
Provider Name | Juddee Anne Maxwell |
First Address | Cadillac, MI 49601-2540 |
Second Address | Cadillac, MI 49601-2540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2009 |
Last Update Date | 22/04/2009 |