Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 106S00000X | Behavior Technician |
NPI | 1003324948 |
---|---|
Provider Name | Sarah Pedersen |
First Address | San Luis Obispo, CA 93401-7736 |
Second Address | San Luis Obispo, CA 93401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2018 |
Last Update Date | 20/08/2018 |