Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | S1501240 | OH |
NPI | 1003309139 |
---|---|
Provider Name | Taylor Leigh Stacy |
First Address | New Albany, OH 43054-8061 |
Second Address | Columbus, OH 43223-1301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2018 |
Last Update Date | 13/06/2018 |