| NPI | 1124546072 |
|---|---|
| Former Name | SUSAN THIBEAULT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CT 711) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2017-08-30 |
| Last Update Date | 2018-11-20 |