Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 58128 | CA |
NPI | 1003044470 |
---|---|
Provider Name | Mrs. Taylor Weidner Roniger |
First Address | New Orleans, LA 70124-1050 |
Second Address | New Orleans, LA 70130-5858 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2009 |
Last Update Date | 12/12/2019 |