Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106S00000X | Behavior Technician |
NPI | 1003359167 |
---|---|
Provider Name | Ms. Kenya Marie Barksdale |
First Address | Saginaw, MI 48603-1408 |
Second Address | Bingham Farms, MI 48025-2454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2016 |
Last Update Date | 10/12/2019 |