Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003235342 |
---|---|
Provider Name | Lachrystal Braggs |
First Address | Chicago, IL 60620-1640 |
Second Address | Chicago, IL 60620-1640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2014 |
Last Update Date | 15/04/2014 |