Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-20-127177 | IN |
NPI | 1003424136 |
---|---|
Provider Name | Elizabeth Marie Tucker |
First Address | Indianapolis, IN 46268-6135 |
Second Address | Jeffersonville, IN 47130-3670 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2020 |
Last Update Date | 15/07/2020 |