Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-16-19532 | MN |
NPI | 1003301243 |
---|---|
Provider Name | Mrs. Shawna Mae Huelsnitz |
First Address | Coon Rapids, MN 55433-5845 |
Second Address | Coon Rapids, MN 55433-5845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2018 |
Last Update Date | 29/06/2018 |