Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-20-142690 | IN |
NPI | 1003412651 |
---|---|
Provider Name | Kennedy Reed |
First Address | Indianapolis, IN 46268-6135 |
Second Address | Marion, IN 46952-3241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2020 |
Last Update Date | 09/12/2020 |