Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003355546 |
---|---|
Provider Name | Rachael Connolly |
First Address | Highland, MI 48356-1155 |
Second Address | Ann Arbor, MI 48108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2017 |
Last Update Date | 16/02/2017 |