Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106E00000X | Assistant Behavior Analyst | CA | |
Y | 106S00000X | Behavior Technician | CA |
NPI | 1033716865 |
---|---|
Provider Name | Alyssa Zigler |
First Address | Modesto, CA 95352-5157 |
Second Address | Modesto, CA 95354-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2020 |
Last Update Date | 21/10/2020 |