Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1295284768 |
---|---|
Provider Name | Kathleen Romo |
First Address | Newton, IA 50208-3712 |
Second Address | Newton, IA 50208-3712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2016 |
Last Update Date | 27/09/2016 |