Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | OH3021943 | OH |
NPI | 1053704353 |
---|---|
Provider Name | Dr. Michele Mckissick |
First Address | Cincinnati, OH 45245-1501 |
Second Address | Cincinnati, OH 45245-1501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2015 |
Last Update Date | 11/03/2015 |