Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 5891 | OH |
N | 103T00000X | Psychologist | 5891 | OH |
Y | 103G00000X | Clinical Psychologist | P.5891 | OH |
Y | 103TC0700X | Clinical Psychologist | P.5891 | OH |
N | 103TH0004X | Health Psychologist | P.5891 | OH |
NPI | 1225121767 |
---|---|
Provider Name | Dr. Jeannine K Abbott |
First Address | Fort Wayne, IN 46856-1167 |
Second Address | Columbus, OH 43219-6223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 30/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0083266 | (05) | OH |