Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-12-4951 |
NPI | 1043575699 |
---|---|
Provider Name | Jillian Rensch |
First Address | Stuart, FL 34997-7462 |
Second Address | Atlanta, GA 30303-1292 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2012 |
Last Update Date | 19/04/2021 |