Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003415746 |
---|---|
Provider Name | Maya Hailey |
First Address | Saint Louis, MO 63112-3403 |
Second Address | Cape Girardeau, MO 63701-2171 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2020 |
Last Update Date | 23/10/2020 |