Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003316514 |
---|---|
Provider Name | Maureen Victoria Wood |
First Address | Woodland Hills, CA 91367-4976 |
Second Address | Grand Rapids, MI 49509-4480 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2018 |
Last Update Date | 20/02/2018 |