Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1083779979 |
---|---|
Provider Name | Mrs. Jendy Wyoma Edgecomb |
First Address | Chico, CA 95926 |
Second Address | Chico, CA 95926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 09/08/2007 |