Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | RBT-17-39309 |
NPI | 1033683867 |
---|---|
Provider Name | Sandra Puckett |
First Address | Nashville, TN 37217-2679 |
Second Address | King Of Prussia, PA 19406-1209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2019 |
Last Update Date | 15/01/2019 |