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General NPI Number Information
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NPI Number | 1063946309
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Entity Type | Individual
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Provider Name | JANA ISOM
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Gender | Female
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Dates
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Enumeration Date | 04/13/2017
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Last Update Date | 04/13/2017
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Provider Practice Location Address
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Address Line | 7301 RIVERS AVE SUITE 100
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-4650
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Country | US
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Telephone | 843-637-4211
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Fax |
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Provider Business Mailing Address
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Address Line | 7301 RIVERS AVE SUITE 100
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-4650
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Country | US
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Telephone | 843-637-4211
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 222790
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License Number State | SC
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