Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-16-24927 | SD |
NPI | 1003196411 |
---|---|
Provider Name | Miss Lisa Ann Weisbecker |
First Address | Sioux Falls, SD 57104-1322 |
Second Address | Sioux Falls, SD 57104-1322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2011 |
Last Update Date | 13/04/2017 |