Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | MN |
NPI | 1083198568 |
---|---|
Provider Name | Lisa Marie Martinson |
First Address | Eden Prairie, MN 55344-3245 |
Second Address | Coon Rapids, MN 55433-5845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2018 |
Last Update Date | 20/09/2018 |