Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003361932 |
---|---|
Provider Name | Kayla Ayne Pollard |
First Address | Springfield, OR 97477-7116 |
Second Address | Springfield, OR 97477-7116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2016 |
Last Update Date | 21/08/2016 |