Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003245184 |
---|---|
Provider Name | Jenna Nicole Micheletti |
First Address | Seattle, WA 98105-3480 |
Second Address | Englewood, CO 80112-5503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2013 |
Last Update Date | 26/11/2018 |