Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6301011292 | MI |
N | 103TH0004X | Health Psychologist | 6301011292 | MI |
N | 103TP2701X | Group Psychotherapist | 6301011292 | MI |
N | 103TR0400X | Rehabilitation Psychologist | 6301011292 | MI |
NPI | 1174715577 |
---|---|
Provider Name | Judy Jaijaetawakwe Sina |
First Address | Haslett, MI 48840-8436 |
Second Address | Haslett, MI 48840-8436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2007 |
Last Update Date | 10/08/2007 |