Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | 1419047 | AZ |
NPI | 1013197144 |
---|---|
Provider Name | Mrs. Cressa Elaine Jeter |
First Address | Phoenix, AZ 85083-4335 |
Second Address | Phoenix, AZ 85083-4335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2007 |
Last Update Date | 06/11/2007 |