Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003418807 |
---|---|
Provider Name | Cailin Elise Capra |
First Address | St Louis Park, MN 55426-4223 |
Second Address | St Louis Park, MN 55426-4223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2020 |
Last Update Date | 16/11/2020 |