Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301017357 | MI |
Y | 103T00000X | Psychologist | 6301017357 | MI |
NPI | 1013484591 |
---|---|
Provider Name | Sonja Bastanin Djapic |
First Address | West Bloomfield, MI 48323-3252 |
Second Address | Troy, MI 48084-4736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2018 |
Last Update Date | 01/11/2018 |