Individual
KENEISHA ENNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15010 107TH AVE, JAMAICA, NY 11433-1902
(917) 376-2340
Mailing address
15010 107TH AVE, JAMAICA, NY 11433-1902
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
04/06/2016
Last updated
04/06/2016
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