Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 1359374 | AZ |
NPI | 1063658094 |
---|---|
Provider Name | Shannon Cronn |
First Address | Phoenix, AZ 85032-1581 |
Second Address | Scottsdale, AZ 85255-3300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2008 |
Last Update Date | 22/12/2008 |