Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | 17-33781 | CA |
NPI | 1003319252 |
---|---|
Provider Name | Callie Shipley |
First Address | Modesto, CA 95352-5157 |
Second Address | Dublin, CA 94568-7726 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2018 |
Last Update Date | 14/03/2018 |