Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 1904559 | IL |
NPI | 1093356529 |
---|---|
Provider Name | Stacie Baker Corder |
First Address | Vermilion, OH 44089-3029 |
Second Address | Vermilion, OH 44089-3029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2019 |
Last Update Date | 06/10/2019 |