NPI | 1346609427 |
---|---|
Former Name | JESSICA REYNOLDS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1100476-SUPV) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.1100476) |
Enumeration Date | 2016-02-17 |
Last Update Date | 2020-05-06 |