Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 3889 | OH |
N | 103T00000X | Psychologist | 3889 | OH |
Y | 103TR0400X | Rehabilitation Psychologist | 3889 | OH |
NPI | 1124039847 |
---|---|
Provider Name | Wanda Mcentyre |
First Address | Columbus, OH 43202-1559 |
Second Address | Columbus, OH 43212-3117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 04/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0805810 | (05) | OH |