Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0134000284 | VA |
NPI | 1124678891 |
---|---|
Provider Name | Katelyn Gatzke |
First Address | Richmond, VA 23230-3011 |
Second Address | Richmond, VA 23230-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2019 |
Last Update Date | 16/09/2019 |