Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-21-49559 | CO |
N | 156F00000X | Technician/Technologist |
NPI | 1033636220 |
---|---|
Provider Name | Jessica M Tondreau |
First Address | Roswell, GA 30076-7938 |
Second Address | Broomfield, CO 80020-2454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2017 |
Last Update Date | 16/09/2021 |