Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-13-14764 | CA |
NPI | 1003246059 |
---|---|
Provider Name | Taeja Kluge |
First Address | Nashville, TN 37211-3678 |
Second Address | Albuquerque, NM 87113-1734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2013 |
Last Update Date | 17/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1-13-14764 | BCBA (01) | CA |