Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003205162 |
---|---|
Provider Name | Victoria Gongaware |
First Address | Lakewood, CO 80226-3054 |
Second Address | Lakewood, CO 80226-3054 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2015 |
Last Update Date | 13/01/2015 |