Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106S00000X | Behavior Technician | ||
Y | 156F00000X | Technician/Technologist |
NPI | 1003451899 |
---|---|
Provider Name | Cassandra Maria Vanbibber |
First Address | Sterling Heights, MI 48312-6392 |
Second Address | Sterling Heights, MI 48312-6392 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2019 |
Last Update Date | 31/08/2021 |