Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003407255 |
---|---|
Provider Name | Alexandra Leigh Terpstra |
First Address | Grand Rapids, MI 49504 |
Second Address | Grand Rapids, MI 49504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2021 |
Last Update Date | 31/01/2021 |