Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 62 | WI |
NPI | 1023287216 |
---|---|
Provider Name | Mrs. Josuane Marie Duckworth |
First Address | Milwaukee, WI 53219-4303 |
Second Address | Milwaukee, WI 53219-4303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2008 |
Last Update Date | 21/02/2008 |