Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | CA | |
N | 106E00000X | Assistant Behavior Analyst | 0-17-8235 | CA |
NPI | 1164939377 |
---|---|
Provider Name | Daniel Kassenbrock |
First Address | Modesto, CA 95352-5157 |
Second Address | Elk Grove, CA 95624-9476 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2018 |
Last Update Date | 29/06/2020 |