Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1003472952 |
---|---|
Provider Name | Macie Reed |
First Address | Ionia, MI 48846-7506 |
Second Address | Ionia, MI 48846-7506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2019 |
Last Update Date | 16/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1715928 | (05) | MI |