Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1053854430 |
---|---|
Provider Name | Brittany Logan |
First Address | Orange Park, FL 32065-5776 |
Second Address | Jacksonville, FL 32256-6746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2016 |
Last Update Date | 02/12/2016 |