Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY-004161 | AZ |
Y | 103T00000X | Psychologist | PSY-004161 | AZ |
N | 103G00000X | Clinical Psychologist | PSY-004161 | AZ |
N | 103TC0700X | Clinical Psychologist | PSY-004161 | AZ |
N | 103TH0100X | Health Service | PSY-004161 | AZ |
NPI | 1154578938 |
---|---|
Provider Name | Dr. Lynda Kristen Vaterlaus |
First Address | Indianapolis, IN 46268-6135 |
Second Address | Phoenix, AZ 85032-4648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2008 |
Last Update Date | 07/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
620393 | (05) | AZ |