Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003389867 |
---|---|
Provider Name | Tia Hennigan |
First Address | Rockville, MD 20855-2733 |
Second Address | Rockville, MD 20855-2733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2019 |
Last Update Date | 04/01/2019 |