Individual
MISS LARA ANN FREDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ED.S. SCHOOL PSYCH
Contact information
Practice address
9419 W VAN BUREN ST, TOLLESON, AZ 85353-2804
(623) 478-4239
Mailing address
16429 S 33RD ST, PHOENIX, AZ 85048-7845
(623) 478-4239
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
AZ
103TS0200X
School Psychologist
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
099101
—
AZ
Enumeration date
10/16/2006
Last updated
07/26/2007
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