Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106S00000X | Behavior Technician |
NPI | 1003414533 |
---|---|
Provider Name | Macie A Anderson |
First Address | Youngstown, OH 44509-2925 |
Second Address | Youngstown, OH 44509-2925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2020 |
Last Update Date | 21/06/2021 |