Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 99000367A | IN |
NPI | 1023238938 |
---|---|
Provider Name | Rachel Njuguna |
First Address | South Bend, IN 46617-2322 |
Second Address | South Bend, IN 46617-2322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 08/07/2007 |