IMAT R AMIDJAYA Clinical Psychologist License verification

Business Entity

CANCELLED

License Type

Clinical Psychologist

Description

REGISTERED PSYCHOLOGIST

License Number

072002036

License Status

CANCELLED

Business

First Name

IMAT R

Last Name

AMIDJAYA

Business Name

IMAT R AMIDJAYA

Original Issue Date

12/28/1976

Expiration Date

09/30/1990

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

09/04/2005