Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6301017067 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301017067 | MI |
NPI | 1003346859 |
---|---|
Provider Name | Ms. Paige S Vannorman |
First Address | Rochester Hills, MI 48309-1700 |
Second Address | Troy, MI 48084-4400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2017 |
Last Update Date | 14/06/2017 |