Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY12777 | CA |
Y | 103T00000X | Psychologist | PSY12777 | CA |
NPI | 1013014018 |
---|---|
Provider Name | Dr. Linda Ann Wall |
First Address | La Canada, CA 91012-0561 |
Second Address | La Canada, CA 91011-3214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |