Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003205865 |
---|---|
Provider Name | Amanda Janette Borman |
First Address | Oak Harbor, WA 98277-4507 |
Second Address | Oak Harbor, WA 98277-3200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2015 |
Last Update Date | 16/01/2015 |