Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1174048441 |
---|---|
Provider Name | Patricia Deiderich |
First Address | Lakewood, CO 80226-2261 |
Second Address | Lakewood, CO 80226-2261 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2017 |
Last Update Date | 08/08/2017 |