Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | BCBA | LA |
NPI | 1003117409 |
---|---|
Provider Name | Kathleen Fontenot |
First Address | Port Allen, LA 70767-2578 |
Second Address | Baton Rouge, LA 70810-1611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2010 |
Last Update Date | 16/11/2010 |