Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | C-083 | LA |
NPI | 1053914499 |
---|---|
Provider Name | Ms. Ashley Thorgeson |
First Address | Baton Rouge, LA 70810-1914 |
Second Address | Baton Rouge, LA 70810-1914 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2020 |
Last Update Date | 18/11/2020 |