Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-19-37351 | MO |
NPI | 1003432972 |
---|---|
Provider Name | Mrs. Stacy R Klusmeier |
First Address | Cape Girardeau, MO 63701-8938 |
Second Address | Cape Girardeau, MO 63701-8938 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2020 |
Last Update Date | 17/06/2020 |