Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1104113083 |
---|---|
Provider Name | Mrs. Stephanie Diane Goldman |
First Address | Weatherford, OK 73096-4239 |
Second Address | Watonga, OK 73772-3636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2011 |
Last Update Date | 29/06/2011 |