Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | AZ |
NPI | 1063603439 |
---|---|
Provider Name | Mrs. Bette Johnson |
First Address | Kayenta, AZ 86033 |
Second Address | Kayenta, AZ 86033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2007 |
Last Update Date | 09/08/2007 |