Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-18-8888 | |
N | 106S00000X | Behavior Technician |
NPI | 1114370889 |
---|---|
Provider Name | Jacob Scott |
First Address | Stuart, FL 34997-7462 |
Second Address | Grand Rapids, MI 49506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2016 |
Last Update Date | 14/08/2019 |