Individual
MRS. TRACEY RENEE SRIDHARAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ED.S., NCSP
Contact information
Practice address
2043 N 64TH DR, PHOENIX, AZ 85035-3424
(623) 691-5518
Mailing address
2513 W PARK ST, PHOENIX, AZ 85041-6488
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
3415771
AZ
Other
Enumeration date
02/11/2007
Last updated
07/08/2007
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