Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 11211765 |
NPI | 1013342096 |
---|---|
Provider Name | Ms. Gladys Chan |
First Address | Stuart, FL 34997-7462 |
Second Address | San Ramon, CA 94583-1344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2013 |
Last Update Date | 14/07/2021 |