Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 3656907 | AZ |
NPI | 1003936261 |
---|---|
Provider Name | Elaine Carder |
First Address | Peoria, AZ 85382-4680 |
Second Address | Glendale, AZ 85306-4002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
967680 | (05) | AZ |