Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1114397445 |
---|---|
Provider Name | Rahsaan Kennard |
First Address | Las Vegas, NV 89130-3150 |
Second Address | Las Vegas, NV 89130-3150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2015 |
Last Update Date | 29/09/2015 |