Individual
JEANETTE BIRK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20470 N LAKE PLEASANT RD STE 107, PEORIA, AZ 85382-9708
(623) 248-3324
Mailing address
20470 N LAKE PLEASANT RD STE 107, PEORIA, AZ 85382-9708
(623) 248-3324
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BEH-000794
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BEH-000794
ARIZONA STATE BOARD OF PSYCHOLOGIST EXAMINERS
AZ
Enumeration date
09/13/2021
Last updated
09/08/2022
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