Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1053873562 |
---|---|
Provider Name | Angela Ilecki |
First Address | Getzville, NY 14068-1205 |
Second Address | Getzville, NY 14068-1205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2019 |
Last Update Date | 18/04/2019 |