Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1104125186 |
---|---|
Provider Name | Sarah Cain Spannagel |
First Address | Euclid, OH 44117-1714 |
Second Address | Cleveland, OH 44106-2205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2011 |
Last Update Date | 22/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0065762 | (05) | OH |