Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-16-22051 |
NPI | 1003279084 |
---|---|
Provider Name | Kasey Tanner |
First Address | Wheeling, WV 26003-2421 |
Second Address | Wheeling, WV 26003-2421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2016 |
Last Update Date | 29/03/2016 |