Individual
GERALD ETSITTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 SOUTH NAVAJO DRIVE, PAGE, AZ 86040
(928) 608-1505
Mailing address
500 SOUTH NAVAJO DRIVE, PAGE, AZ 86040
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
4389376
AZ
Other
Enumeration date
09/13/2011
Last updated
09/13/2011
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