Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 2021011010 | MO |
NPI | 1003494774 |
---|---|
Provider Name | Amanda Gilmor |
First Address | Washington, MO 63090-1705 |
Second Address | Saint Louis, MO 63141-7103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2021 |
Last Update Date | 01/04/2021 |