Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | L2053661 | MI |
NPI | 1003158296 |
---|---|
Provider Name | Jana Lee Penrod |
First Address | Adrian, MI 49221-2131 |
Second Address | Adrian, MI 49221-2131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2013 |
Last Update Date | 26/03/2013 |