Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 106S00000X | Behavior Technician |
NPI | 1003350463 |
---|---|
Provider Name | Ryan Fournier |
First Address | Lakeland, MI 48143-0663 |
Second Address | Saginaw, MI 48638-5977 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2016 |
Last Update Date | 26/12/2018 |