Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-08-4015 |
NPI | 1003214487 |
---|---|
Provider Name | Tara Glavin |
First Address | Chicago, IL 60642-8873 |
Second Address | Chicago, IL 60642-8873 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2014 |
Last Update Date | 16/12/2014 |