Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1134696354 |
---|---|
Provider Name | Jessica L Campbell |
First Address | Lakeland, MI 48143-0663 |
Second Address | Pinckney, MI 48169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2018 |
Last Update Date | 11/12/2019 |