Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-13-12730 | FL |
NPI | 1013270388 |
---|---|
Provider Name | Shannon Koehler |
First Address | Aberdeen, SD 57401-4172 |
Second Address | Aberdeen, SD 57401-4172 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2012 |
Last Update Date | 22/02/2017 |