Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 3575333 | OR |
NPI | 1003450222 |
---|---|
Provider Name | Hailee Tyne Fischer |
First Address | Woodland Hills, CA 91367-7807 |
Second Address | Gresham, OR 97030-5629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2019 |
Last Update Date | 30/10/2019 |