Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003405655 |
---|---|
Provider Name | David Thompson Hadaway III |
First Address | Lafayette, CO 80026-8879 |
Second Address | Boulder, CO 80305-7321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2021 |
Last Update Date | 18/01/2021 |