Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003328394 |
---|---|
Provider Name | Kelsey Lynn Wood |
First Address | Anson, TX 79501-6117 |
Second Address | Anson, TX 79501-6117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2017 |
Last Update Date | 26/10/2017 |