Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003374950 |
---|---|
Provider Name | Zoe Lydia Bacon |
First Address | Lakewood, CO 80228-6514 |
Second Address | Northglenn, CO 80234-2920 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2019 |
Last Update Date | 11/03/2019 |