Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 3718669 | AZ |
NPI | 1093376204 |
---|---|
Provider Name | Angela Cole |
First Address | Fountain Hills, AZ 85268-6663 |
Second Address | Fountain Hills, AZ 85268-6663 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2019 |
Last Update Date | 27/06/2019 |