Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003254988 |
---|---|
Provider Name | Cordelia Ruth Cochran |
First Address | Puyallup, WA 98372-3265 |
Second Address | Puyallup, WA 98372-3265 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2013 |
Last Update Date | 29/04/2014 |