Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 4050854 | AZ |
NPI | 1053576967 |
---|---|
Provider Name | Jennifer Lynn Fielder |
First Address | Goodyear, AZ 85338-3357 |
Second Address | Goodyear, AZ 85338-3357 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2008 |
Last Update Date | 21/07/2008 |