Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | CG60716828 | WA |
Y | 106E00000X | Assistant Behavior Analyst | RBT-17-27887 | WA |
NPI | 1043755887 |
---|---|
Provider Name | Jennifer Hupper |
First Address | Silverdale, WA 98383-8365 |
Second Address | Silverdale, WA 98383-8365 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2017 |
Last Update Date | 04/01/2017 |