Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-09-6526 | CA |
NPI | 1003189242 |
---|---|
Provider Name | Angela Pao-Johnson |
First Address | La Grange, IL 60526-1870 |
Second Address | Crandall, TX 75114-5138 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2012 |
Last Update Date | 14/10/2020 |