Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 2041 | CO |
Y | 103T00000X | Psychologist | 2041 | CO |
NPI | 1003940099 |
---|---|
Provider Name | Joan Laub |
First Address | Centennial, CO 80111-4628 |
Second Address | Centennial, CO 80111-4628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |