Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6301008499 | MI |
NPI | 1124560719 |
---|---|
Provider Name | Kristine Dunn-Wsner |
First Address | Flint, MI 48502-2002 |
Second Address | Flint, MI 48502-2002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2016 |
Last Update Date | 14/11/2016 |