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General NPI Number Information
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NPI Number | 1770041337
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Entity Type | Individual
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Provider Name | MISS CASSANDRA LYNN BODNAR
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Gender | Female
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Dates
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Enumeration Date | 03/03/2019
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Last Update Date | 06/05/2020
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Provider Practice Location Address
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Address Line | 2035 S 4TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19148-2550
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Country | US
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Telephone | 312-965-2997
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Fax |
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Provider Business Mailing Address
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Address Line | 5211 SENTINEL RDG
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City | NORRISTOWN
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State | PA
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Zip | 19403-5275
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Country | US
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Telephone | 215-756-7218
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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 |
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