Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | 338 | OH |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 338 | OH |
N | 103TF0000X | Family Psychologist | 338 | OH |
NPI | 1225095805 |
---|---|
Provider Name | Suzanne H Hetrick |
First Address | Stow, OH 44224-1411 |
Second Address | Stow, OH 44224-1411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 08/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R80374 | (02) |