Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | CB60813620 | WA |
N | 106E00000X | Assistant Behavior Analyst |
NPI | 1003327867 |
---|---|
Provider Name | Ms. Kaitlyn Roesler |
First Address | Yakima, WA 98902-6340 |
Second Address | Yakima, WA 98902-6340 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2017 |
Last Update Date | 01/02/2018 |