Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | CO | |
N | 106S00000X | Behavior Technician | VA |
NPI | 1023521549 |
---|---|
Provider Name | Taylor Lee Fontanez |
First Address | Colorado Springs, CO 80915-1501 |
Second Address | Colorado Springs, CO 80915-1501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2017 |
Last Update Date | 26/01/2021 |