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General NPI Number Information
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NPI Number | 1740468883
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Entity Type | Individual
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Provider Name | LAURA JEAN KASSYMOVA M.A.
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Gender | Female
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 1110 E MISSOURI AVE SUITE 160
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City | PHOENIX
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State | AZ
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Zip | 85014-2707
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Country | US
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Telephone | 602-274-1311
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Fax | 602-889-0900
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Provider Business Mailing Address
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Address Line | 1110 E. MISSOURI AVE SUITE 160
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City | PHOENIX
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State | AZ
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Zip | 85014-2751
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Country | US
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Telephone | 602-274-1311
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Fax | 602-889-0900
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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 |
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License Number State | AZ
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