Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 6401012493 | MI |
N | 101YS0200X | School Counselor | SC0000000771196 | MI |
NPI | 1043645120 |
---|---|
Provider Name | Jennifer S Laboda |
First Address | Macomb, MI 48042-2329 |
Second Address | Macomb, MI 48042-2329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2013 |
Last Update Date | 09/09/2013 |