Individual
MICHAEL PROKOP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
641 FAIRWAY DR NE, WARREN, OH 44483-5633
(330) 766-2492
Mailing address
641 FAIRWAY DR NE, WARREN, OH 44483-5633
(330) 766-2492
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
BG1-00-9474
OH
Other
Enumeration date
07/22/2015
Last updated
07/22/2015
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