Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 1115507171 | NY |
NPI | 1023536349 |
---|---|
Provider Name | Mrs. Jessica Neilans |
First Address | Williamsville, NY 14221-3906 |
Second Address | Cheektowaga, NY 14225-1851 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2017 |
Last Update Date | 07/09/2017 |