Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 3302 | NC |
Y | 103TC0700X | Clinical Psychologist | 3302 | NC |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 3302 | NC |
NPI | 1093922429 |
---|---|
Provider Name | Linda Oldham Ikle |
First Address | Wilmington, NC 28401-7747 |
Second Address | Wilmington, NC 28401-7747 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 26/02/2008 |