Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 9002 | WV |
NPI | 1053560599 |
---|---|
Provider Name | Elizabeth Willard |
First Address | Dunbar, WV 25064-1711 |
Second Address | Charleston, WV 25311-2119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2008 |
Last Update Date | 09/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810010085 | (05) | WV |