Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TS0200X | School Psychologist | 1391338 | IN |
Y | 103TS0200X | School Psychologist | 5077742 | AZ |
NPI | 1053826545 |
---|---|
Provider Name | Angela Coyle |
First Address | Marana, AZ 85658-4735 |
Second Address | Marana, AZ 85658-4735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2017 |
Last Update Date | 26/09/2018 |