Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | WA |
NPI | 1003262643 |
---|---|
Provider Name | Jessica Davis |
First Address | Seattle, WA 98199-3239 |
Second Address | Seattle, WA 98199-3239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2016 |
Last Update Date | 12/01/2017 |