Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 758 | NE |
NPI | 1124284690 |
---|---|
Provider Name | Ashley C Harlow |
First Address | Omaha, NE 68114-2764 |
Second Address | Omaha, NE 68114-2764 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2008 |
Last Update Date | 19/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47037660631 | (05) | NE |