Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-08-4532 | CA |
NPI | 1003163478 |
---|---|
Provider Name | Miss Jennifer Lane Styzens |
First Address | Seal Beach, CA 90740-6023 |
Second Address | Seal Beach, CA 90740-6023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2012 |
Last Update Date | 05/08/2012 |