Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | AZ |
NPI | 1013194315 |
---|---|
Provider Name | Rick Weathers |
First Address | Phoenix, AZ 85014-2751 |
Second Address | Phoenix, AZ 85014-2751 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2008 |
Last Update Date | 11/02/2008 |