Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003415225 |
---|---|
Provider Name | Molly Kathleen Hickey |
First Address | Walnut Creek, CA 94596-5218 |
Second Address | Walnut Creek, CA 94596-5218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2020 |
Last Update Date | 19/10/2020 |