Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 031085 | OH |
NPI | 1003190174 |
---|---|
Provider Name | Mrs. Nirupma Jetley |
First Address | Perrysburg, OH 43551-5300 |
Second Address | Perrysburg, OH 43551-5300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2011 |
Last Update Date | 06/10/2011 |