Individual
JACQUELINE KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
930 S DETROIT AVE, TOLEDO, OH 43614-2701
(419) 381-1881
Mailing address
30 E BROAD ST, 11TH FL ATTN: TONYA FASONE, COLUMBUS, OH 43215-3414
(614) 466-9930
(614) 644-9116
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
5546
OH
Other
Enumeration date
10/05/2006
Last updated
07/21/2022
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