Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 36945 | TX |
Y | 103T00000X | Psychologist | 36945 | TX |
N | 103TS0200X | School Psychologist | 70461 | TX |
NPI | 1083190284 |
---|---|
Provider Name | Kelly Sopchak |
First Address | Cincinnati, OH 45219-2504 |
Second Address | Cincinnati, OH 45219-2504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2018 |
Last Update Date | 11/07/2018 |