Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-12-5199 | IN |
NPI | 1164776217 |
---|---|
Provider Name | Elaine Smith |
First Address | Kokomo, IN 46901-2573 |
Second Address | Greensburg, IN 47240-6647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2012 |
Last Update Date | 08/08/2019 |