Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 106500000X | UT |
NPI | 1114418761 |
---|---|
Provider Name | Michele Shields |
First Address | Salt Lake City, UT 84102-2161 |
Second Address | Salt Lake City, UT 84102-2161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2018 |
Last Update Date | 18/05/2018 |