Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 10684061-2506 | UT |
N | 106E00000X | Assistant Behavior Analyst | 01-17-8434 | UT |
N | 106S00000X | Behavior Technician |
NPI | 1023554441 |
---|---|
Provider Name | Josepheve Martindale |
First Address | Bountiful, UT 84010-8905 |
Second Address | Bountiful, UT 84010-8905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2017 |
Last Update Date | 13/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023554441 | (05) | UT |