Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1003219387 |
---|---|
Provider Name | Derrick Skinner IV |
First Address | Celina, OH 45822-1736 |
Second Address | Celina, OH 45822-1736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2014 |
Last Update Date | 01/10/2014 |