Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003387846 |
---|---|
Provider Name | Taylor Combs |
First Address | Salt Lake City, UT 84106-6004 |
Second Address | Salt Lake City, UT 84106-6004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2018 |
Last Update Date | 05/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R414-1 | (05) | UT |