Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0134000343 | VA |
NPI | 1114529310 |
---|---|
Provider Name | Emily Jo Baker |
First Address | Roanoke, VA 24015-1738 |
Second Address | Roanoke, VA 24018-6515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2020 |
Last Update Date | 12/11/2020 |