Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | I.1801020 | OH |
NPI | 1003267048 |
---|---|
Provider Name | Shameka Perry |
First Address | Fairfield, OH 45014-4297 |
Second Address | Fairfield, OH 45014-4297 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2016 |
Last Update Date | 18/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2847496 | (05) | OH |