Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003210196 |
---|---|
Provider Name | Mr. Joshua Caleb Crider |
First Address | Medford, OR 97501 |
Second Address | Medford, OR 97501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2014 |
Last Update Date | 17/10/2014 |