Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 11486362-2507 | UT |
N | 106E00000X | Assistant Behavior Analyst | 2814 | TX |
NPI | 1063973626 |
---|---|
Provider Name | Courtney Beckstrand Stewart |
First Address | Layton, UT 84040-6617 |
Second Address | Layton, UT 84040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2019 |
Last Update Date | 07/10/2019 |