Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY 4182 | FL |
Y | 103TC0700X | Clinical Psychologist | PY 4182 | FL |
NPI | 1003971722 |
---|---|
Provider Name | Suellyn Vanderslice |
First Address | Panama City, FL 32401-2030 |
Second Address | Panama City, FL 32401-2030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 27/09/2013 |