Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1773 | KY |
Y | 103TC0700X | Clinical Psychologist | 1773 | KY |
N | 103G00000X | Clinical Psychologist | 7126 | OH |
N | 103TC0700X | Clinical Psychologist | 7126 | OH |
NPI | 1932515251 |
---|---|
Provider Name | Dr. Anna Sofie Shouse |
First Address | Fort Thomas, KY 41075-2453 |
Second Address | Fort Thomas, KY 41075-2453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2014 |
Last Update Date | 08/07/2014 |