Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 11355362-2507 | UT |
NPI | 1164809117 |
---|---|
Provider Name | Kori Lowe |
First Address | Taylorsvile, UT 84123 |
Second Address | Taylorsvile, UT 84123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2015 |
Last Update Date | 07/10/2019 |