Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-04-1846 | FL |
NPI | 1003048539 |
---|---|
Provider Name | Stacey Osmon |
First Address | Lakeland, FL 33806-2112 |
Second Address | Lakeland, FL 33812-6392 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2009 |
Last Update Date | 24/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
687700196 | (05) | FL |
687700198 | (05) | FL |