Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | CA |
NPI | 1053897306 |
---|---|
Provider Name | Heather Collins |
First Address | Weed, CA 96094-9445 |
Second Address | Yreka, CA 96097-3110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2018 |
Last Update Date | 18/07/2018 |