Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
N | 106E00000X | Assistant Behavior Analyst | ||
Y | 106E00000X | Assistant Behavior Analyst | 0167393 |
NPI | 1053762401 |
---|---|
Provider Name | Jennifer Dawn Vergara |
First Address | Tampa, FL 33614-4682 |
Second Address | Odessa, FL 33556-2637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2016 |
Last Update Date | 17/03/2018 |