Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 9300 | WV |
NPI | 1063687341 |
---|---|
Provider Name | Leann Chandler |
First Address | Martinsburg, WV 25404 |
Second Address | Charles Town, WV 25414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2008 |
Last Update Date | 28/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810008264 | (05) | WV |