Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 106E00000X | Assistant Behavior Analyst |
NPI | 1003344573 |
---|---|
Provider Name | Jessie Stretton |
First Address | Lake Mary, FL 32746-5028 |
Second Address | Tampa, FL 33612-5513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2017 |
Last Update Date | 07/06/2021 |