Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003240656 |
---|---|
Provider Name | Teresa Beth Kozell-Wingett |
First Address | Keizer, OR 97303-3768 |
Second Address | Keizer, OR 97303-3768 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2013 |
Last Update Date | 05/09/2013 |