Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 387 | WY |
Y | 103TC0700X | Clinical Psychologist | 387 | WY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 387 | WY |
NPI | 1043756174 |
---|---|
Provider Name | Maribeth L. Hesser |
First Address | Jackson, WY 83001-9390 |
Second Address | Jackson, WY 83001-9390 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2017 |
Last Update Date | 12/01/2017 |