Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 001360 | IA |
NPI | 1023367018 |
---|---|
Provider Name | Michelle Leigh Cushman |
First Address | Ankeny, IA 50023-3008 |
Second Address | Ankeny, IA 50023-3008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2012 |
Last Update Date | 28/12/2021 |