Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YS0200X | School Counselor | 11617731 | PA |
N | 101YS0200X | School Counselor | 819725 | NJ |
Y | 103K00000X | Behavior Analyst | BH000202 | PA |
NPI | 1124434303 |
---|---|
Provider Name | Miss Kayla Petronella |
First Address | Catasauqua, PA 18032-1137 |
Second Address | Catasauqua, PA 18032-1137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2014 |
Last Update Date | 08/07/2014 |