Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YS0200X | School Counselor | 06610965 | PA |
Y | 103K00000X | Behavior Analyst | BH000913 | PA |
NPI | 1154731644 |
---|---|
Provider Name | Mrs. Kelly Smith |
First Address | Manheim, PA 17545-9134 |
Second Address | Manheim, PA 17545-9134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2014 |
Last Update Date | 06/05/2014 |