Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | AZ |
NPI | 1255455036 |
---|---|
Provider Name | Rachel Willis |
First Address | Wickenburg, AZ 85390-1411 |
Second Address | Wickenburg, AZ 85390 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 13/02/2008 |