Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003267618 |
---|---|
Provider Name | Kinsey Anne Johnson |
First Address | Le Claire, IA 52753-9627 |
Second Address | Moline, IL 61265-1539 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2016 |
Last Update Date | 24/06/2016 |