Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1043973852 |
---|---|
Provider Name | Kallie Kathryn Leathers |
First Address | Grand Blanc, MI 48439-8169 |
Second Address | Grand Blanc, MI 48439-8169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2021 |
Last Update Date | 19/10/2021 |