Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 0803000122 | VA |
NPI | 1043330517 |
---|---|
Provider Name | Ann T. Benson |
First Address | Blacksburg, VA 24060-2708 |
Second Address | Blacksburg, VA 24060-2708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
119081 | TRIGON PROVIDER NUMBER (01) | VA |