Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003389511 |
---|---|
Provider Name | Jessica Baldwin |
First Address | Medford, OR 97501-2734 |
Second Address | Medford, OR 97501-2734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2019 |
Last Update Date | 16/04/2019 |