Individual
DR. JACQUELINE COUNTRYMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
601 S EDWIN C MOSES BLVD, EAST BUILDING, 4TH FLOOR, DAYTON, OH 45408-1424
(937) 276-8333
Mailing address
601 S EDWIN C MOSES BLVD, EAST BUILDING, 4TH FLOOR, DAYTON, OH 45408-1424
(937) 276-8333
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
35-07-3384-C
OH
Other
Enumeration date
01/02/2007
Last updated
07/08/2007
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