| NPI | 1548831704 | 
|---|---|
| Former Name | GRACE CORNELISON | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: GA 0-24-15293) | 
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-17-42634) | 
| Enumeration Date | 2021-07-08 | 
| Last Update Date | 2024-06-03 |