Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1306326707 |
---|---|
Provider Name | Mallory Ronan |
First Address | Orchard Park, NY 14127-1069 |
Second Address | Orchard Park, NY 14127-1069 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2018 |
Last Update Date | 16/08/2018 |