Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 2012001901 | MO |
NPI | 1013288034 |
---|---|
Provider Name | Ms. Brooke Eileen Burnett |
First Address | Columbia, MO 65201-6521 |
Second Address | Columbia, MO 65201-6521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2012 |
Last Update Date | 23/01/2012 |