Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 0813000161 | VA |
NPI | 1063910545 |
---|---|
Provider Name | Janet Brockington Kegley |
First Address | Roanoke, VA 24012-4611 |
Second Address | Roanoke, VA 24012-4611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2018 |
Last Update Date | 30/01/2018 |