Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003371071 |
---|---|
Provider Name | Masha Kozhevnikova |
First Address | Lakewood, CO 80228-6514 |
Second Address | Arcata, CA 95521-5789 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2019 |
Last Update Date | 04/02/2019 |