Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-21-12730 | FL |
NPI | 1164022018 |
---|---|
Provider Name | Jaleesa Elwin |
First Address | Oviedo, FL 32765-9035 |
Second Address | Casselberry, FL 32707-5372 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2020 |
Last Update Date | 09/09/2021 |