Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | S.1903694 | OH |
NPI | 1003350448 |
---|---|
Provider Name | Ethan Thomas Craig |
First Address | Marion, OH 43302-8764 |
Second Address | Marion, OH 43302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2016 |
Last Update Date | 31/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003350448 | (05) | OH |