Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106E00000X | Assistant Behavior Analyst | ||
Y | 106E00000X | Assistant Behavior Analyst | 0-21-12518 | |
N | 106S00000X | Behavior Technician | 10707 |
NPI | 1023638855 |
---|---|
Provider Name | Autumn Stocking |
First Address | Rapid City, SD 57702-2467 |
Second Address | Rapid City, SD 57702-2467 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2020 |
Last Update Date | 02/08/2021 |