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General NPI Number Information
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NPI Number | 1043035884
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Entity Type | Individual
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Provider Name | LA'SHANDRIA TA'SHAY WOODSON RBT
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Gender | Female
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 107 FINANCIAL PLACE
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-8450
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Country | US
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Telephone | 270-763-8225
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Fax |
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Provider Business Mailing Address
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Address Line | 107 FINANCIAL DRIVE
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701
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Country | US
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Telephone | 270-763-8225
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-24-391242
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License Number State | KY
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