Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1134529332 |
---|---|
Provider Name | Lisa M Rieck |
First Address | Ormond Beach, FL 32174-8021 |
Second Address | Ormond Beach, FL 32174-8021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2014 |
Last Update Date | 17/03/2018 |