Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106S00000X | Behavior Technician | ||
Y | 106S00000X | Behavior Technician | RBT-17-37213 | UT |
NPI | 1003326067 |
---|---|
Provider Name | Jessica Sury |
First Address | Saint George, UT 84790-7305 |
Second Address | Saint George, UT 84790-7305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2017 |
Last Update Date | 04/10/2017 |