Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TS0200X | School Psychologist | 4059688 | AZ |
Y | 111N00000X | Chiropractor | 5973 | AZ |
NPI | 1023318078 |
---|---|
Provider Name | Larissa Woolston |
First Address | Scottsdale, AZ 85258-1235 |
Second Address | Scottsdale, AZ 85258-1235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2010 |
Last Update Date | 25/08/2016 |