Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | MM1-02-2478 JJSF107 | OH |
NPI | 1093139404 |
---|---|
Provider Name | Jeri Petro |
First Address | West Chester, OH 45069-2948 |
Second Address | West Chester, OH 45069-2948 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2014 |
Last Update Date | 06/02/2014 |