Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 746 | KS |
NPI | 1164572905 |
---|---|
Provider Name | Mrs. Kirstin K Olson Moerike |
First Address | Shawnee, KS 66218-9086 |
Second Address | Kansas City, KS 66112-2152 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 08/07/2007 |