Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | REGULAR II-A | DC |
NPI | 1053749945 |
---|---|
Provider Name | Julia Krystyna Lesiczka |
First Address | Rockville, MD 20850-2011 |
Second Address | Washington, DC 20002-3361 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2013 |
Last Update Date | 31/10/2013 |