Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 156F00000X | Technician/Technologist | ||
N | 156F00000X | Technician/Technologist | 0082013411158 | MI |
N | 156F00000X | Technician/Technologist | P600707139401 | MI |
NPI | 1316408503 |
---|---|
Provider Name | Qeara Deshawn Perry |
First Address | Bingham Farms, MI 48025-2454 |
Second Address | Warren, MI 48089-4815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2019 |
Last Update Date | 29/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103344666 | (05) | MI |