Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | S1201277 | OH |
NPI | 1003160631 |
---|---|
Provider Name | Elissa Nichole Hostetter |
First Address | Piqua, OH 45356-7527 |
Second Address | Moraine, OH 45439-1983 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2012 |
Last Update Date | 05/11/2012 |