Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003402579 |
---|---|
Provider Name | Raisah Sheppard |
First Address | Pasadena, CA 91106-2380 |
Second Address | Greensboro, NC 27407-1636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2020 |
Last Update Date | 17/12/2020 |