Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003377904 |
---|---|
Provider Name | Jacqueline Burkett |
First Address | Baltimore, MD 21209-1080 |
Second Address | Baltimore, MD 21209-1080 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2019 |
Last Update Date | 26/03/2019 |