Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 4372321 | AZ |
NPI | 1053690578 |
---|---|
Provider Name | Ms. Amy H. Mcgovern |
First Address | Phoenix, AZ 85028-4140 |
Second Address | Phoenix, AZ 85013-3688 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2011 |
Last Update Date | 15/08/2011 |