Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1063899763 |
---|---|
Provider Name | Tyler Sasser |
First Address | State College, PA 16801-4640 |
Second Address | State College, PA 16801-4640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2015 |
Last Update Date | 01/05/2015 |