Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 157317 | AK |
N | 106S00000X | Behavior Technician | BACB322523 | AK |
NPI | 1083145833 |
---|---|
Provider Name | Ms. Marie Shela L Salonga |
First Address | Eagle River, AK 99577-8024 |
Second Address | Eagle River, AK 99577-8024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2017 |
Last Update Date | 09/03/2020 |