Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1073938270 |
---|---|
Provider Name | Nicole Shannon |
First Address | Loudonville, OH 44842-9524 |
Second Address | Loudonville, OH 44842-9524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2014 |
Last Update Date | 25/02/2014 |