| NPI | 1336582873 |
|---|---|
| Former Name | COLLEEN CAROL TEDLUND |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH60817961) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60333393) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2024-06-12 |