Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003478025 |
---|---|
Provider Name | Mallory Veronica Bauer |
First Address | Woodland Hills, CA 91367-4976 |
Second Address | Colchester, VT 05446-3187 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2019 |
Last Update Date | 29/06/2019 |