Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003315920 |
---|---|
Provider Name | Tracy Duckett |
First Address | King Of Prussia, PA 19406-4201 |
Second Address | Mount Laurel, NJ 08054-4015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2018 |
Last Update Date | 06/02/2018 |