Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-19-36064 | IN |
NPI | 1003477845 |
---|---|
Provider Name | Courtney Nicole Steele |
First Address | Mishawaka, IN 46545-3424 |
Second Address | Mishawaka, IN 46545-3424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2019 |
Last Update Date | 11/12/2019 |