Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | OR |
NPI | 1114461829 |
---|---|
Provider Name | Jill Summers |
First Address | Salem, OR 97305-1220 |
Second Address | Salem, OR 97305-1220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2016 |
Last Update Date | 14/12/2016 |