Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1114304672 |
---|---|
Provider Name | Colleen Ada Bannister |
First Address | Athol, MA 01331-1846 |
Second Address | Athol, MA 01331-1846 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2015 |
Last Update Date | 04/05/2015 |