Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 170198018 | CA |
NPI | 1033873021 |
---|---|
Provider Name | Susan Demotte |
First Address | Stockton, CA 95207-3641 |
Second Address | Stockton, CA 95207-3641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2021 |
Last Update Date | 26/10/2021 |