Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106E00000X | Assistant Behavior Analyst |
NPI | 1043777410 |
---|---|
Provider Name | Eloise Gerken |
First Address | Fairfield, CA 94534-8610 |
Second Address | Napa, CA 94559-1746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2019 |
Last Update Date | 30/04/2021 |