Jacob Shain
Behavior Technician in Glendale, AZ. Individual provider (NPI-1).
NPI number1003484064
StatusActive
Last updated in NPPESJun 16, 2021
Details
- NPI
- 1003484064
- Entity type
- Individual (NPI-1)
- Name
- Jacob Shain
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 16, 2021
- Certification date
- Jun 16, 2021
- Last updated
- Jun 16, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
17235 N 75th AveSuite G-120
Glendale, AZ 85308-0831
Phone 303-989-8169
Mailing address
17235 N 75th AveSuite G-120
Glendale, AZ 85308-0831
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