Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 20525283 | OH |
NPI | 1013302843 |
---|---|
Provider Name | Sherri Mackenzie |
First Address | Riverside, OH 45431-1238 |
Second Address | Riverside, OH 45431-1238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2015 |
Last Update Date | 30/03/2015 |