Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 2018027338 | MO |
NPI | 1124508288 |
---|---|
Provider Name | Megan Violi |
First Address | Affton, MO 63123-4549 |
Second Address | Saint Louis, MO 63141-7103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2018 |
Last Update Date | 17/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1952508277 | (05) | MO |