Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1104408350 |
---|---|
Provider Name | Hailie Durst |
First Address | Warren, OH 44484-2958 |
Second Address | Warren, OH 44484-2958 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2021 |
Last Update Date | 27/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
UN560096 | DRIVER LICENSE (01) | OH |