Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1043516941 |
---|---|
Provider Name | Lauren K Wong |
First Address | Chico, CA 95926 |
Second Address | Chico, CA 95926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2011 |
Last Update Date | 10/02/2011 |