Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | AZ |
NPI | 1134313729 |
---|---|
Provider Name | Tanja Gromala |
First Address | Kingman, AZ 86409-3303 |
Second Address | Kingman, AZ 86409-3303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 29/08/2007 |