Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | BHOO1700 | PA |
NPI | 1003293598 |
---|---|
Provider Name | Karen Jean Iverson |
First Address | Philadelphia, PA 19151-3112 |
Second Address | Philadelphia, PA 19151-3112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2015 |
Last Update Date | 04/05/2015 |