Individual
ANGELA JAYNE BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
3095 KETTERING BLVD FL 4, MORAINE, OH 45439-1983
(937) 293-8300
(937) 913-1913
Mailing address
3095 KETTERING BLVD FL 4, MORAINE, OH 45439-1983
(937) 293-8300
(937) 913-1913
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
S.2106441
OH
Other
Enumeration date
04/05/2018
Last updated
04/28/2022
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