Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1063994218 |
---|---|
Provider Name | Tyshawna Frazer-New |
First Address | Fairborn, OH 45324-1139 |
Second Address | Fairborn, OH 45324-1139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2018 |
Last Update Date | 04/09/2018 |