Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | VA1001857 | OH |
NPI | 1043621527 |
---|---|
Provider Name | Mrs. Leisha Rego |
First Address | Cleveland, OH 44114-1137 |
Second Address | Cleveland, OH 44114-1137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2014 |
Last Update Date | 18/05/2014 |