Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | OH3221084 | OH |
NPI | 1083087951 |
---|---|
Provider Name | Craig Hanthorn |
First Address | Cincinnati, OH 45251-5907 |
Second Address | Cincinnati, OH 45251-5907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2015 |
Last Update Date | 02/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
251300000X | (05) | OH |