Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | OH3083836 | OH |
NPI | 1073923033 |
---|---|
Provider Name | Renee Hart |
First Address | Lakewood, OH 44107-3918 |
Second Address | Lakewood, OH 44107-3918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2014 |
Last Update Date | 30/04/2014 |