Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | AZ |
NPI | 1063694628 |
---|---|
Provider Name | Ms. Kensey R Sheline |
First Address | Phoenix, AZ 85013-3618 |
Second Address | Phoenix, AZ 85013-3618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2007 |
Last Update Date | 10/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
968969 | AHCCCS (01) | AZ |