Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003392747 |
---|---|
Provider Name | Heather Martensen |
First Address | Shreveport, LA 71101-4621 |
Second Address | San Angelo, TX 76904-6803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2018 |
Last Update Date | 17/01/2019 |