Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | BH-4784 | AZ |
NPI | 1043675838 |
---|---|
Provider Name | Clarisse Kamgaing |
First Address | Chandler, AZ 85249-4636 |
Second Address | Gilbert, AZ 85298 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2015 |
Last Update Date | 21/12/2015 |