Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 106E00000X | Assistant Behavior Analyst | ||
N | 106S00000X | Behavior Technician |
NPI | 1144855602 |
---|---|
Provider Name | Latesha Shinese Wood |
First Address | Dupont, WA 98327-8773 |
Second Address | Dupont, WA 98327-8773 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2020 |
Last Update Date | 06/12/2021 |