Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | BACB291360 | VA |
NPI | 1003347030 |
---|---|
Provider Name | Shanyn Hansen |
First Address | Troutville, VA 24175-6413 |
Second Address | Troutville, VA 24175-6413 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2017 |
Last Update Date | 22/03/2017 |