Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-20-44842 | CA |
N | 106S00000X | Behavior Technician |
NPI | 1003373234 |
---|---|
Provider Name | Jeremy Walker |
First Address | Temecula, CA 92592-6527 |
Second Address | Murrieta, CA 92563-2633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2019 |
Last Update Date | 16/12/2020 |