Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 2006 | KS |
NPI | 1063656890 |
---|---|
Provider Name | Michelle C Moeder |
First Address | Wichita, KS 67210-1651 |
Second Address | Wichita, KS 67203-5902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2009 |
Last Update Date | 02/12/2009 |