Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | AZ |
NPI | 1083796395 |
---|---|
Provider Name | Sarah Rees |
First Address | Phoenix, AZ 85032-4441 |
Second Address | Phoenix, AZ 85032-4441 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 26/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
644402 | (05) | AZ |