Individual
SPRING IDALE HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDCA
Contact information
Practice address
418 COLEGATE DR, MARIETTA, OH 45750-9549
(740) 374-8730
Mailing address
418 COLEGATE DR, MARIETTA, OH 45750-9549
(740) 374-8730
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
174649
OH
Other
Enumeration date
10/30/2020
Last updated
11/02/2020
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