Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1013360221 |
---|---|
Provider Name | Mary Katherine Longenecker |
First Address | Federal Way, WA 98003-4770 |
Second Address | Federal Way, WA 98003-4770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2016 |
Last Update Date | 22/07/2016 |