Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | S 1500289 | OH |
NPI | 1003269044 |
---|---|
Provider Name | Brittany Waltenbaugh |
First Address | Wooster, OH 44691-7904 |
Second Address | Wooster, OH 44691-7904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2016 |
Last Update Date | 14/07/2016 |