Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-14-5793 | CA |
NPI | 1043731847 |
---|---|
Provider Name | Rosalie Gwerder |
First Address | Modesto, CA 95352-5157 |
Second Address | Tracy, CA 95377-8119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2017 |
Last Update Date | 30/06/2017 |