Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003266461 |
---|---|
Provider Name | Sara Fiedler |
First Address | Vancouver, WA 98662-6192 |
Second Address | Vancouver, WA 98662-6192 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2016 |
Last Update Date | 16/06/2016 |