Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 4258252 | AZ |
NPI | 1033425715 |
---|---|
Provider Name | Miss Meghan A Kimball |
First Address | Mesa, AZ 85201-3307 |
Second Address | Mesa, AZ 85201-3307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2010 |
Last Update Date | 19/08/2010 |