Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003353541 |
---|---|
Provider Name | Jennie Lord |
First Address | Jacksonville, FL 32256-9024 |
Second Address | Jacksonville, FL 32256-9024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2017 |
Last Update Date | 23/01/2017 |