Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 627 | IA |
NPI | 1063470060 |
---|---|
Provider Name | Dr. Anne M Green |
First Address | Coralville, IA 52241-1882 |
Second Address | Coralville, IA 52241-1882 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 09/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
54265 | WELLMARK (01) | IA |