Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1114504578 |
---|---|
Provider Name | Rachel Kennedy |
First Address | Hemet, CA 92544-4504 |
Second Address | Corona, CA 92879-1387 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2021 |
Last Update Date | 04/01/2022 |