Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | $$$$$$$$$ | AZ |
NPI | 1063644490 |
---|---|
Provider Name | Katherine Drake |
First Address | Tucson, AZ 85711-4411 |
Second Address | Tucson, AZ 85711-4411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2009 |
Last Update Date | 18/08/2009 |