Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-16-22193 | KY |
NPI | 1023557774 |
---|---|
Provider Name | Kelsey Donoho |
First Address | Lacenter, KY 42056 |
Second Address | Lacenter, KY 42056 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2017 |
Last Update Date | 14/02/2017 |