Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | 10259770 | IN |
NPI | 1154074904 |
---|---|
Provider Name | Keshia Southern |
First Address | Whiteland, IN 46184-9548 |
Second Address | Whiteland, IN 46184 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2022 |
Last Update Date | 01/02/2022 |