| NPI | 1669057287 |
|---|---|
| Former Name | SALLY ANN FREDERICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801084828) |
| Enumeration Date | 2021-03-15 |
| Last Update Date | 2024-06-05 |