Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | SP0000000792258 | MI |
NPI | 1073119632 |
---|---|
Provider Name | Kristen Ryder |
First Address | Cedar, MI 49621-0240 |
Second Address | New York, NY 10018-4878 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2020 |
Last Update Date | 07/01/2021 |