Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YS0200X | School Counselor | 3585131 | AZ |
N | 103TS0200X | School Psychologist | 3585131 | AZ |
NPI | 1114144433 |
---|---|
Provider Name | Sandra Lee Macdougall-Jacobs |
First Address | Yuma, AZ 85364-4251 |
Second Address | Yuma, AZ 85364-4251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 08/07/2007 |