Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1184153652 |
---|---|
Provider Name | Jessica Walden |
First Address | Las Vegas, NV 89128-7674 |
Second Address | Las Vegas, NV 89128-7674 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2017 |
Last Update Date | 08/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000000000 | (05) | NV |