Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 556010 | UT |
NPI | 1013276559 |
---|---|
Provider Name | Ben Springer |
First Address | Heber City, UT 84032-4457 |
Second Address | Heber City, UT 84032-4457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2012 |
Last Update Date | 03/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
556010 | PROFESSIONAL EDUCATOR LICENSE (01) | UT |