Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-20-142691 | GA |
NPI | 1003408600 |
---|---|
Provider Name | Savannah Vasquez |
First Address | Indianapolis, IN 46268-6135 |
Second Address | Marietta, GA 30067-9309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2021 |
Last Update Date | 05/02/2021 |