Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003311804 |
---|---|
Provider Name | Jesennie Sieg |
First Address | Emeryville, CA 94608-1738 |
Second Address | Monterey, CA 93940-3118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2018 |
Last Update Date | 26/03/2018 |