Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | OH |
NPI | 1003341785 |
---|---|
Provider Name | Amy Siebold |
First Address | Detroit, MI 48278-1625 |
Second Address | Westerville, OH 43081-2890 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2017 |
Last Update Date | 06/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1473276 | (05) | OH |