CARLA A TIETZ Clinical Psychologist License verification

Business Entity

ACTIVE

License Type

Clinical Psychologist

Description

CLINICAL PSYCHOLOGIST

License Number

071004476

License Status

ACTIVE

Business

First Name

CARLA

Middle

Last Name

TIETZ

Business Name

CARLA A TIETZ

Original Issue Date

05/19/1992

Effective Date

09/12/2024

Expiration Date

09/30/2026

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

09/12/2024