Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | C 0800262 | OH |
NPI | 1003049602 |
---|---|
Provider Name | Jonna Marie Brendle |
First Address | Bowling Green, OH 43402-2975 |
Second Address | Bowling Green, OH 43402-2975 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2009 |
Last Update Date | 29/08/2009 |