Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 0093033 | FL |
NPI | 1013207463 |
---|---|
Provider Name | Jennifer Lynn Virostek |
First Address | Oakland Park, FL 33309-6247 |
Second Address | Oakland Park, FL 33309-6247 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2011 |
Last Update Date | 19/04/2011 |