Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | 140121627 | CA |
NPI | 1093191157 |
---|---|
Provider Name | Taylor Edgcomb |
First Address | Buffalo, WY 82834-2510 |
Second Address | Buffalo, WY 82834-2510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2015 |
Last Update Date | 17/08/2015 |