Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1043722762 |
---|---|
Provider Name | Devore Jenkins |
First Address | Pahokee, FL 33476-2302 |
Second Address | Pahokee, FL 33476-2302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2017 |
Last Update Date | 03/11/2017 |