Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003324005 |
---|---|
Provider Name | Aubrey Marie Hardyway |
First Address | Wichita, KS 67226-2169 |
Second Address | Wichita, KS 67226-2169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2018 |
Last Update Date | 12/01/2018 |