Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003309246 |
---|---|
Provider Name | Jennifer Lee |
First Address | Santa Maria, CA 93454-6608 |
Second Address | Santa Maria, CA 93454-6608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2018 |
Last Update Date | 12/06/2018 |