Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1154944056 |
---|---|
Provider Name | Lashaunta Wilson |
First Address | Las Vegas, NV 89103-2280 |
Second Address | Las Vegas, NV 89102-1506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2020 |
Last Update Date | 26/05/2020 |