Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023505823 |
---|---|
Provider Name | Annie Linn Stoddard |
First Address | San Rafael, CA 94903-3680 |
Second Address | Greenbrae, CA 94904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2018 |
Last Update Date | 26/06/2018 |