Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003253394 |
---|---|
Provider Name | Stephanie Brockman |
First Address | Phoenix, AZ 85006-4103 |
Second Address | Phoenix, AZ 85006-4103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2013 |
Last Update Date | 14/03/2017 |