NPI | 1093326233 |
---|---|
Former Name | KRYSTA JEAN DEXTER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OH SP.15327) |
Additional Taxonomies | 106S00000X Behavior Technician (Licence: OH RBT-19-89854) |
Enumeration Date | 2020-08-12 |
Last Update Date | 2023-04-20 |