Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1104362896 |
---|---|
Provider Name | Ms. Jenna Stauffer |
First Address | Alhambra, CA 91803-8800 |
Second Address | Alhambra, CA 91803-8800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2017 |
Last Update Date | 18/01/2017 |