Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | Y6296150 | CA |
NPI | 1134899701 |
---|---|
Provider Name | Danielle B Shackleford |
First Address | La Mesa, CA 91942-0272 |
Second Address | La Mesa, CA 91942-0272 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2021 |
Last Update Date | 15/09/2021 |