Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003308602 |
---|---|
Provider Name | Valerie Johnson |
First Address | Saint Louis, MO 63146-4758 |
Second Address | Kirksville, MO 63501-4526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2018 |
Last Update Date | 31/05/2018 |