Individual
KELLY ANTOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED.
Contact information
Practice address
585 RIVERSIDE DR, PAINESVILLE, OH 44077-5323
(440) 352-3854
Mailing address
585 RIVERSIDE DR, PAINESVILLE, OH 44077-5323
(440) 352-3854
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
OH3053621
OH
Other
Enumeration date
08/25/2014
Last updated
08/26/2014
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