Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003040007 |
---|---|
Provider Name | Miss Lynn Marie Kennelly |
First Address | Lebanon, PA 17046-5040 |
Second Address | Lebanon, PA 17046-4065 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2009 |
Last Update Date | 09/08/2011 |