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General NPI Number Information
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NPI Number | 1215680293
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Entity Type | Individual
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Provider Name | CONNIE LEE HALE EDUC. PSYCHOLOGIST
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Gender | Female
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 22360 KERENSA COURT
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City | MI WUK VILLAGE
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State | CA
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Zip | 95346-9534
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Country | US
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Telephone | 209-743-0238
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 249
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City | MI WUK VILLAGE
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State | CA
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Zip | 95346-0249
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Country | US
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Telephone | 209-743-0238
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 3288
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License Number State | CA
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