Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1225574916 |
---|---|
Provider Name | Jarred Radebaugh |
First Address | Thornton, CO 80260-6806 |
Second Address | Thornton, CO 80260-6806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2017 |
Last Update Date | 19/01/2017 |