Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 106E00000X | Assistant Behavior Analyst |
NPI | 1134669344 |
---|---|
Provider Name | Amanda Gillette |
First Address | Slc, UT 84102-2855 |
Second Address | San Diego, CA 92131-1140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2017 |
Last Update Date | 26/09/2018 |