Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 3319 | CO |
N | 103TS0200X | School Psychologist | 0380805 | CO |
NPI | 1003048497 |
---|---|
Provider Name | Dr. Brooke Kish |
First Address | Evergreen, CO 80439-7715 |
Second Address | Parker, CO 80138-8575 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2009 |
Last Update Date | 18/08/2009 |