Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003363789 |
---|---|
Provider Name | Latoya Sherese Brown |
First Address | Kentwood, MI 49512-1966 |
Second Address | Kentwood, MI 49512-2809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2016 |
Last Update Date | 17/03/2018 |