Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106E00000X | Assistant Behavior Analyst | GA | |
Y | 106S00000X | Behavior Technician |
NPI | 1053702878 |
---|---|
Provider Name | Jennifer Wahl |
First Address | Evans, GA 30809-8250 |
Second Address | Evans, GA 30809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2015 |
Last Update Date | 14/10/2020 |