Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | SP00660 | OH |
Y | 103T00000X | Psychologist | SP00660 | OH |
N | 103TS0200X | School Psychologist | SP00660 | OH |
NPI | 1013524669 |
---|---|
Provider Name | Mrs. Wesley Holmes Konesky |
First Address | Bowling Green, OH 43402-5234 |
Second Address | Sylvania, OH 43560-2795 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2020 |
Last Update Date | 28/09/2020 |