Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | CG60576157 | WA |
NPI | 1003290172 |
---|---|
Provider Name | Vivinet Y Acevedo- Martinez |
First Address | Yakima, WA 98908-3479 |
Second Address | Wenatchee, WA 98801-3081 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2015 |
Last Update Date | 21/04/2017 |