Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003227448 |
---|---|
Provider Name | Amanda Goodell |
First Address | Clinton Township, MI 48038-1656 |
Second Address | Clinton Township, MI 48038-1155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2014 |
Last Update Date | 28/09/2016 |