Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 05510 | MD |
NPI | 1033518261 |
---|---|
Provider Name | Jill Haak Bohnenkamp |
First Address | Baltimore, MD 21201-1009 |
Second Address | Baltimore, MD 21201-1023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2014 |
Last Update Date | 13/08/2014 |