Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1013341684 |
---|---|
Provider Name | Ms. Susan C Crockett |
First Address | North Las Vegas, NV 89030-4711 |
Second Address | Las Vegas, NV 89130-3180 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2013 |
Last Update Date | 30/08/2013 |