Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | AZ |
NPI | 1023222957 |
---|---|
Provider Name | Kiersten Walker |
First Address | Goodyear, AZ 85338-9634 |
Second Address | Goodyear, AZ 85338-9634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 26/07/2007 |