Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | BH001482 | PA |
NPI | 1003216748 |
---|---|
Provider Name | Jessica Smith |
First Address | Hulmeville, PA 19047-5818 |
Second Address | Hulmeville, PA 19047-5818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2014 |
Last Update Date | 31/08/2014 |