Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TS0200X | School Psychologist | AZ |
NPI | 1104054741 |
---|---|
Provider Name | Ashley L Smith |
First Address | Chicago, IL 60657-2756 |
Second Address | Chicago, IL 60620-1304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2009 |
Last Update Date | 03/06/2016 |