Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1154507259 |
---|---|
Provider Name | Wendy Beranek |
First Address | Antlers, OK 74523-1030 |
Second Address | Durant, OK 74701-4700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2008 |
Last Update Date | 05/06/2012 |