Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | OH1485147 | OH |
NPI | 1043525041 |
---|---|
Provider Name | Amanda Kathleen Brace |
First Address | Kent, OH 44240-2208 |
Second Address | Kent, OH 44240-2208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2010 |
Last Update Date | 13/08/2010 |