Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003336926 |
---|---|
Provider Name | Kaelynn Boyd |
First Address | Amite, LA 70422-2817 |
Second Address | Amite, LA 70422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2017 |
Last Update Date | 21/06/2017 |