Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3245 | OH |
Y | 103T00000X | Psychologist | 3245 | OH |
NPI | 1003844184 |
---|---|
Provider Name | Susan M. Knell |
First Address | Mayfield Village, OH 44143 |
Second Address | Mayfield Village, OH 44143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 08/07/2007 |