Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | 00096802 | IL |
NPI | 1093105678 |
---|---|
Provider Name | Amanda J. Stark |
First Address | Columbus, OH 43218-2848 |
Second Address | Dublin, OH 43016-3246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2015 |
Last Update Date | 03/02/2015 |