Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 218-140 | WI |
NPI | 1003316399 |
---|---|
Provider Name | Corina M Colon |
First Address | La Farge, WI 54639 |
Second Address | La Crosse, WI 54603-2616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2018 |
Last Update Date | 14/02/2018 |