Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 1243 | KY |
N | 103T00000X | Psychologist | 1243 | KY |
Y | 103G00000X | Clinical Psychologist | 5809 | OH |
Y | 103TC0700X | Clinical Psychologist | 5809 | OH |
NPI | 1003854712 |
---|---|
Provider Name | Brett Dowdy |
First Address | Mason, OH 45040-3104 |
Second Address | Mason, OH 45040-3104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 12/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
184607 | MEDICARE GROUP NUMBER (01) | KY |
DOCP28581 | (02) | OH |