| NPI | 1053879650 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MS S4677) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-19-79242) |
| Enumeration Date | 2019-03-04 |
| Last Update Date | 2020-06-08 |