Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-18-62532 | IL |
NPI | 1003395450 |
---|---|
Provider Name | Tiara Arrington |
First Address | Park Forest, IL 60466-1422 |
Second Address | Park Forest, IL 60466-1422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2018 |
Last Update Date | 07/08/2018 |