Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003042771 |
---|---|
Provider Name | Mrs. Codi Renne Canning |
First Address | Guthrie, OK 73044-6506 |
Second Address | Guthrie, OK 73044-6506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2009 |
Last Update Date | 08/06/2009 |