Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003368291 |
---|---|
Provider Name | Hannah Smith |
First Address | Salt Lake City, UT 84102-2801 |
Second Address | Salt Lake City, UT 84102-2801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2016 |
Last Update Date | 23/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1396085718 | (05) | UT |