Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | SP372 | OH |
NPI | 1053461038 |
---|---|
Provider Name | Dr. Gwenn K. Heintzelman |
First Address | Cincinnati, OH 45236-2994 |
Second Address | Cincinnati, OH 45236-2994 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |