Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 103TR0400X | Rehabilitation Psychologist | 00229977 | WA |
NPI | 1508238924 |
---|---|
Provider Name | Rebecca Stafford |
First Address | Lacey, WA 98516-7162 |
Second Address | Lacey, WA 98516-7162 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2015 |
Last Update Date | 14/12/2016 |