Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | TN |
NPI | 1003365503 |
---|---|
Provider Name | Wendi Y Minutolo |
First Address | Johnson City, TN 37601-2040 |
Second Address | Johnson City, TN 37601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2016 |
Last Update Date | 15/08/2018 |