Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003170804 |
---|---|
Provider Name | Karen Glenn |
First Address | Mead, OK 73449-0048 |
Second Address | Ardmore, OK 73401-7013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2012 |
Last Update Date | 27/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100708380A | (05) | OK |
200049040 | (05) | OK |