Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003265125 |
---|---|
Provider Name | Letasha Anne Tedrow |
First Address | Indiana, PA 15701-1372 |
Second Address | Du Bois, PA 15801-1152 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2016 |
Last Update Date | 09/06/2016 |