Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YS0200X | School Counselor | OH | |
Y | 104100000X | Social Worker | OH |
NPI | 1164825196 |
---|---|
Provider Name | Kaitlin Doherty |
First Address | Broadview Hts, OH 44147-3420 |
Second Address | Broadview Hts, OH 44147-3420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2014 |
Last Update Date | 05/10/2014 |