Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1134648470 |
---|---|
Provider Name | Jackie R Aucoin |
First Address | Cincinnati, OH 45244-1557 |
Second Address | Cincinnati, OH 45244-1518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2017 |
Last Update Date | 09/07/2019 |