Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 2005 | KS |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2011031728 | MO |
NPI | 1033368659 |
---|---|
Provider Name | Sara Rebecca Gould |
First Address | Kansas City, MO 64108-4619 |
Second Address | Kansas City, MO 64108-4619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2008 |
Last Update Date | 09/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1841281805 | (05) | KS |