Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-21-57092 | CA |
N | 106S00000X | Behavior Technician |
NPI | 1003374703 |
---|---|
Provider Name | Mrs. Elizabeth Ashley Monroe |
First Address | Gardena, CA 90248-3858 |
Second Address | Palmdale, CA 93550-7143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2019 |
Last Update Date | 14/01/2022 |