Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-19-37687 | |
N | 106E00000X | Assistant Behavior Analyst | 0-17-7917 |
NPI | 1144731407 |
---|---|
Provider Name | Taylor Janine Randall |
First Address | Lakeland, FL 33807-6553 |
Second Address | Lakeland, FL 33811-2383 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2017 |
Last Update Date | 26/09/2019 |