Organization
MOHICAN YOUTH ACADEMY
Active
Organization
MOHICAN YOUTH ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY BRUNO (CREDENTIALING)
(614) 556-4616
Entity
Organization
Contact information
Practice address
1012 ODNR MOHICAN 51, PERRYSVILLE, OH 44864-9407
(419) 994-0300
Mailing address
1012 ODNR MOHICAN 51, PERRYSVILLE, OH 44864-9407
(419) 994-0300
Taxonomy
Speciality
Code
Description
License number
State
2084P0005X
Neurodevelopmental Disabilities Physician
Primary
—
—
Other
Enumeration date
11/18/2017
Last updated
11/18/2017
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