Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-07-3354 | VT |
NPI | 1003184292 |
---|---|
Provider Name | Christina Vetter Raisanen |
First Address | Burlington, VT 05401-5429 |
Second Address | Burlington, VT 05401-5353 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2011 |
Last Update Date | 02/12/2011 |