Basic Information
| Provider Information | |||||||||
| NPI: | 1548776529 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATERS | ||||||||
| FirstName: | LASHONDA | ||||||||
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| Credential: | PSYM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3640 COLONEL GLENN HWY. | ||||||||
| Address2: | 117 HEALTH SCIENCES BLDG. | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454350001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377753458 | ||||||||
| FaxNumber: | 9377753434 | ||||||||
| Practice Location | |||||||||
| Address1: | 3333 BURNET AVENUE MLC 4002 | ||||||||
| Address2: | THE KELLY O'LEARY CENTER FOR AUTISM SPECTRUM DISORDERS | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452292029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136361778 | ||||||||
| FaxNumber: | 5136361759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2017 | ||||||||
| LastUpdateDate: | 12/28/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | OH | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.