Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003414608 |
---|---|
Provider Name | Anna Kondaurov |
First Address | Peoria, AZ 85382-3356 |
Second Address | Peoria, AZ 85382-3356 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2020 |
Last Update Date | 15/10/2020 |