Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003302860 |
---|---|
Provider Name | Jacey Marie Hanna |
First Address | Sioux City, IA 51105-1945 |
Second Address | Sioux City, IA 51105-1945 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2018 |
Last Update Date | 05/07/2018 |