Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | WA |
NPI | 1174057921 |
---|---|
Provider Name | Cheyenne Passmore |
First Address | Bonney Lake, WA 98391 |
Second Address | Bonney Lake, WA 98391-8494 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2017 |
Last Update Date | 20/04/2017 |