Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003310814 |
---|---|
Provider Name | Kenzie Bisbee |
First Address | Sacramento, CA 95834-2041 |
Second Address | Sacramento, CA 95834-2041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2018 |
Last Update Date | 19/03/2018 |