Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 001130 | IA |
N | 103TC1900X | Counseling Psychologist | PSY 20420 | CA |
NPI | 1114038635 |
---|---|
Provider Name | Dr. Sarah Fraley |
First Address | Iowa City, IA 52246 |
Second Address | Iowa City, IA 52246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 26/10/2009 |