Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | S112170027 | MO |
NPI | 1124507082 |
---|---|
Provider Name | Kelsey Shay Hladik |
First Address | Woodland Hills, CA 91367-7807 |
Second Address | Kahului, HI 96732-2999 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2018 |
Last Update Date | 11/08/2018 |