Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | IA |
NPI | 1003321241 |
---|---|
Provider Name | Tatiana Leclair |
First Address | Ankeny, IA 50021-4011 |
Second Address | Ankeny, IA 50021-4011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2017 |
Last Update Date | 11/12/2017 |