Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003403965 |
---|---|
Provider Name | Miss Heather Ann Waterson |
First Address | Woodland Hills, CA 91367-7807 |
Second Address | O Fallon, IL 62269-3746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2020 |
Last Update Date | 28/12/2020 |