Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1326408741 |
---|---|
Provider Name | Ellen Sandberg |
First Address | Las Vegas, NV 89128-2291 |
Second Address | Las Vegas, NV 89121-5954 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2016 |
Last Update Date | 26/02/2016 |