Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 6053 | OH |
N | 103TC0700X | Clinical Psychologist | 6053 | OH |
Y | 102L00000X | Psychologist | 6053 | OH |
Y | 103T00000X | Psychologist | 6053 | OH |
N | 103TR0400X | Rehabilitation Psychologist | 6053 | OH |
NPI | 1538172283 |
---|---|
Provider Name | Julie Simensky |
First Address | Ypsilanti, MI 48197-1104 |
Second Address | Ypsilanti, MI 48197-1104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 02/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2533422 | (05) | OH |