Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1134252836 |
---|---|
Provider Name | Mrs. Renea Lynn Herold |
First Address | Phoenix, AZ 85085-7402 |
Second Address | Glendale, AZ 85310-5201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 08/07/2007 |