Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | OH1242264 | OH |
NPI | 1093125916 |
---|---|
Provider Name | Mr. Jeffrey William Johnson |
First Address | Warren, OH 44481-1219 |
Second Address | Warren, OH 44483-5195 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2014 |
Last Update Date | 30/04/2014 |