Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 291923 | NM |
NPI | 1063968402 |
---|---|
Provider Name | Susan Plecha |
First Address | Albuquerque, NM 87120-1342 |
Second Address | Socorro, NM 87801-4666 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2016 |
Last Update Date | 26/08/2016 |