Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1023206679 |
---|---|
Provider Name | Ms. Laurie Malles |
First Address | Phoenix, AZ 85017-2316 |
Second Address | Phoenix, AZ 85017-2316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2007 |
Last Update Date | 09/10/2007 |