Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003117805 |
---|---|
Provider Name | Colleen Cornwall |
First Address | Naples, FL 34116-7459 |
Second Address | Naples, FL 34116-7459 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2010 |
Last Update Date | 26/10/2021 |