Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 225400000X | Rehabilitation Practitioner |
NPI | 1033763545 |
---|---|
Provider Name | Cecilia Ladenburg |
First Address | Tacoma, WA 98407-3799 |
Second Address | Tacoma, WA 98407-3799 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2019 |
Last Update Date | 19/10/2021 |