Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003420639 |
---|---|
Provider Name | Stacie Cannell |
First Address | Kansas City, MO 64151-1483 |
Second Address | Leavenworth, KS 66048-1124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2020 |
Last Update Date | 01/09/2020 |