Individual
SUSAN DEMOTTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1164 W BENJAMIN HOLT DR, STOCKTON, CA 95207-3641
(209) 403-4403
Mailing address
1164 W BENJAMIN HOLT DR, STOCKTON, CA 95207-3641
(209) 403-4403
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
170198018
CA
Other
Enumeration date
10/26/2021
Last updated
10/26/2021
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