Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 106S00000X | Behavior Technician |
NPI | 1003240342 |
---|---|
Provider Name | Katalina Takuvaka |
First Address | Salt Lake City, UT 84124-3550 |
Second Address | Salt Lake City, UT 84124-3550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2013 |
Last Update Date | 20/11/2020 |