Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | ||
N | 106S00000X | Behavior Technician | OH |
NPI | 1134585839 |
---|---|
Provider Name | Alexandra Latham |
First Address | Fairlawn, OH 44333-3339 |
Second Address | Fairlawn, OH 44333-3339 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2016 |
Last Update Date | 03/04/2019 |