Individual
JACK STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
801 OLD HARSHMAN RD, RIVERSIDE, OH 45431-1238
(937) 259-6603
(937) 259-6611
Mailing address
801 OLD HARSHMAN RD, RIVERSIDE, OH 45431-1238
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
1155279
OH
Other
Enumeration date
02/12/2014
Last updated
02/12/2014
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