Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | I1000115 | OH |
NPI | 1003205121 |
---|---|
Provider Name | Crysta Fletcher |
First Address | Cincinnati, OH 45227-1426 |
Second Address | Cincinnati, OH 45239-7688 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2015 |
Last Update Date | 20/12/2017 |