Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1205092194 |
---|---|
Provider Name | Ms. Ilsa Marie Bednar |
First Address | Tucson, AZ 85714-1626 |
Second Address | Tucson, AZ 85714-1626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2008 |
Last Update Date | 31/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
108219 | ACCESS (01) | AZ |