Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1083132922 |
---|---|
Provider Name | Krista Mcleod |
First Address | Port Huron, MI 48060-8127 |
Second Address | Port Huron, MI 48060-8127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2017 |
Last Update Date | 30/08/2017 |