Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-15-04355 | IL |
NPI | 1003359829 |
---|---|
Provider Name | Aisha Payne |
First Address | Aurora, IL 60502-9612 |
Second Address | Aurora, IL 60502-9612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2016 |
Last Update Date | 28/11/2016 |