Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-16-18059 | CA |
NPI | 1003324351 |
---|---|
Provider Name | Kathryn Wise |
First Address | Camarillo, CA 93012-8710 |
Second Address | Camarillo, CA 93012-8710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2018 |
Last Update Date | 19/01/2018 |