Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 4739 | OH |
N | 103TC0700X | Clinical Psychologist | 4739 | OH |
Y | 103G00000X | Clinical Psychologist | 4739 | OH |
Y | 103TC0700X | Clinical Psychologist | 4739 | OH |
N | 103TR0400X | Rehabilitation Psychologist | 4739 | OH |
NPI | 1659400588 |
---|---|
Provider Name | Dr. Dawn E Bouman |
First Address | Cincinnati, OH 45263-6256 |
Second Address | Cincinnati, OH 45216-1015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 23/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0961786 | (05) | OH |
R72400 | (02) | OH |