Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-19-10644 | GA |
NPI | 1093354946 |
---|---|
Provider Name | Ms. Katherine Marie Santiago |
First Address | Valdosta, GA 31602-7058 |
Second Address | Valdosta, GA 31602-2881 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2019 |
Last Update Date | 24/12/2019 |