Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | OTH-003890 | AZ |
NPI | 1215168943 |
---|---|
Provider Name | Barbaraann F Dausend |
First Address | Peoria, AZ 85383-2764 |
Second Address | Peoria, AZ 85383-2764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2009 |
Last Update Date | 24/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
446793 | (05) | AZ |