Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC-11882 | AZ |
NPI | 1003003583 |
---|---|
Provider Name | Judith A Wiseman |
First Address | Phoenix, AZ 85051 |
Second Address | Phoenix, AZ 85051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2007 |
Last Update Date | 28/09/2007 |