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General NPI Number Information
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NPI Number | 1619725959
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Entity Type | Individual
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Provider Name | IMANI WINDOM
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Gender | Female
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Dates
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Enumeration Date | 05/10/2024
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 1771 E FLAMINGO RD STE 220A
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City | LAS VEGAS
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State | NV
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Zip | 89119-0850
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Country | US
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Telephone | 702-560-2912
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Fax |
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Provider Business Mailing Address
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Address Line | 12350 DEL AMO BLVD APT 2611
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City | LAKEWOOD
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State | CA
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Zip | 90715-1728
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Country | US
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Telephone | 562-293-6519
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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 |
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License Number State | CA
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