Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TS0200X | School Psychologist | OH3175653 | OH |
Y | 103TS0200X | School Psychologist | SP.00661 | OH |
NPI | 1083160998 |
---|---|
Provider Name | Sophia Whitehouse |
First Address | Powell, OH 43065-8711 |
Second Address | Powell, OH 43065-8711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2016 |
Last Update Date | 12/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1083160998 | (05) | OH |