Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY-005165 | AZ |
Y | 103T00000X | Psychologist | PSY-005165 | AZ |
NPI | 1003589169 |
---|---|
Provider Name | Amanda Aaron Hackwell |
First Address | Phoenix, AZ 85032-4441 |
Second Address | Scottsdale, AZ 85254-1383 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2021 |
Last Update Date | 26/07/2021 |