Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003319286 |
---|---|
Provider Name | Kay Lavonne Brown |
First Address | Minnetonka, MN 55305-3461 |
Second Address | Minnetonka, MN 55305-3461 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2018 |
Last Update Date | 14/03/2018 |