Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 3870260 | AZ |
NPI | 1073781084 |
---|---|
Provider Name | Mr. Reid Axman |
First Address | Laveen, AZ 85339-5048 |
Second Address | Phoenix, AZ 85043-7717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2008 |
Last Update Date | 12/02/2008 |