Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | OH1462384 | OH |
NPI | 1033529342 |
---|---|
Provider Name | Mr. Chad Wilson |
First Address | Brooklyn, OH 44144 |
Second Address | Brooklyn, OH 44144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2014 |
Last Update Date | 08/05/2014 |