Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1003490319 |
---|---|
Provider Name | Marissa Marie Hall |
First Address | Jackson, MI 49202-3560 |
Second Address | Jackson, MI 49202-2979 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2021 |
Last Update Date | 12/05/2021 |