Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | AZ |
NPI | 1083751655 |
---|---|
Provider Name | Dr. Richard Schowengerdt |
First Address | Scottsdale, AZ 85250-6768 |
Second Address | Scottsdale, AZ 85250-6768 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 26/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
713588 | (05) | AZ |