Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | AZ |
NPI | 1023197779 |
---|---|
Provider Name | Mr. Robert Bruce St Pierre |
First Address | Maricopa, AZ 85239-2526 |
Second Address | Tempe, AZ 85282-2252 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 26/07/2007 |