Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1013138510 |
---|---|
Provider Name | Joe Rauschenbach |
First Address | Flagstaff, AZ 86004-1845 |
Second Address | Flagstaff, AZ 86004-3207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |