Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003260175 |
---|---|
Provider Name | Dena Kime |
First Address | Mount Vernon, IL 62864-6548 |
Second Address | Mount Vernon, IL 62864-6548 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2016 |
Last Update Date | 14/04/2016 |