Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003323064 |
---|---|
Provider Name | Jordan Louk I |
First Address | Shelby, OH 44875-2115 |
Second Address | Mansfield, OH 44907-2424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2017 |
Last Update Date | 29/12/2017 |