Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | 111268 | IL |
NPI | 1154964286 |
---|---|
Provider Name | Kiera Bulford |
First Address | New Haven, CT 06511-5720 |
Second Address | New Haven, CT 06513-3091 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2019 |
Last Update Date | 22/10/2019 |