Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-14-5775 | WA |
NPI | 1134547193 |
---|---|
Provider Name | Mrs. Bethany Grace Nelson |
First Address | Covington, WA 98042-6020 |
Second Address | Silverdale, WA 98383-8365 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2014 |
Last Update Date | 17/03/2018 |