Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 7402000135 | MI |
N | 106S00000X | Behavior Technician |
NPI | 1083110209 |
---|---|
Provider Name | Sean Brady |
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 | 05/04/2018 |
Last Update Date | 06/12/2021 |