Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 11640 | FL |
N | 106S00000X | Behavior Technician |
NPI | 1114532421 |
---|---|
Provider Name | Briana Marie Diederichsen |
First Address | Navarre, FL 32566-3610 |
Second Address | Navarre, FL 32566-7305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2020 |
Last Update Date | 02/08/2021 |