Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | 0146013 | CA |
Y | 103K00000X | Behavior Analyst | 1-16-21381 | CA |
NPI | 1013316017 |
---|---|
Provider Name | Jenna Faith Sant-Wing |
First Address | Springfield, OR 97477-7948 |
Second Address | La Mesa, CA 91942-0476 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2014 |
Last Update Date | 11/07/2016 |