Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 4391 | OH |
NPI | 1124159314 |
---|---|
Provider Name | Janet Kay Souder |
First Address | Westerville, OH 43081-2890 |
Second Address | Westerville, OH 43081-2890 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 10/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0139552 | (05) | OH |