Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | BACB558868 | IN |
NPI | 1003409236 |
---|---|
Provider Name | Juanita Marie Parris |
First Address | Hammond, IN 46320-2508 |
Second Address | Highland, IN 46322-1631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2021 |
Last Update Date | 18/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102957273099 | (05) | IN |