Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | KU1-01-0892. | OH |
NPI | 1033534128 |
---|---|
Provider Name | Julimarie Mishak |
First Address | Lorain, OH 44052-4648 |
Second Address | Lorain, OH 44052-4648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2014 |
Last Update Date | 26/02/2014 |