Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | ||
N | 106S00000X | Behavior Technician |
NPI | 1013404326 |
---|---|
Provider Name | Lady Anne Gange |
First Address | Irvine, CA 92606-2417 |
Second Address | Chula Vista, CA 91910-3990 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2018 |
Last Update Date | 08/02/2022 |