Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 103TS0200X | School Psychologist |
NPI | 1043646714 |
---|---|
Provider Name | Wanda I Santiago |
First Address | Orlando, FL 32824-4204 |
Second Address | Orlando, FL 32824-4204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2013 |
Last Update Date | 02/11/2016 |