Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 1275972 | OH |
NPI | 1073096806 |
---|---|
Provider Name | Kate Boelky |
First Address | Lancaster, OH 43130-8045 |
Second Address | Lancaster, OH 43130-8045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2018 |
Last Update Date | 07/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OH1275972 | OHIO DEPARTMENT OF EDUCATION LICENSURE (01) | OH |