Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1205060894 |
---|---|
Provider Name | Carolyn R Ingram |
First Address | Dubuque, IA 52001-3042 |
Second Address | Dubuque, IA 52001-6809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2009 |
Last Update Date | 11/05/2009 |