Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1053990267 |
---|---|
Provider Name | Mrs. Mckenna Rickabaugh |
First Address | Reno, NV 89502-1562 |
Second Address | Reno, NV 89502-1562 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2021 |
Last Update Date | 05/04/2021 |