Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-20-142158 | AZ |
NPI | 1003411570 |
---|---|
Provider Name | Claudia Dickson |
First Address | Indianapolis, IN 46268-6135 |
Second Address | Tucson, AZ 85710-7342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2020 |
Last Update Date | 02/12/2020 |