Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1114545340 |
---|---|
Provider Name | Jordan Kenneth Dekker |
First Address | Woodland Hills, CA 91367-7807 |
Second Address | Vancouver, WA 98685-4528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2020 |
Last Update Date | 14/07/2020 |