Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 6951 | CA |
N | 103TC0700X | Clinical Psychologist | 6951 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 6951 | CA |
NPI | 1104020189 |
---|---|
Provider Name | Ms. Kay Wickett Ostensen |
First Address | Laguna Beach, CA 92651 |
Second Address | Laguna Beach, CA 92651 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 08/07/2007 |