Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003383423 |
---|---|
Provider Name | Jade Hubbard |
First Address | Pontiac, MI 48340-3300 |
Second Address | Dearborn, MI 48126-4812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2018 |
Last Update Date | 24/10/2018 |