Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | BH001204 | PA |
NPI | 1083202329 |
---|---|
Provider Name | Amy Repko |
First Address | Wexford, PA 15090-6885 |
Second Address | Wexford, PA 15090-6885 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2021 |
Last Update Date | 04/01/2021 |