Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1063048825 |
---|---|
Provider Name | Stacy Kreutzer |
First Address | San Diego, CA 92122-3019 |
Second Address | San Diego, CA 92122-3019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2020 |
Last Update Date | 12/03/2020 |