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Individual

NICOLE DANIELLE SHAW

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, NCC, LBS

Contact information

Practice address
1400 FOX HILL RD STE 100, STATE COLLEGE, PA 16803-1877
(814) 238-4851
Mailing address
14OO FOXHILL ROAD SUITE 100, STATE COLLEGE, PA 16803
(814) 238-4851

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
004571
PA

Other

Enumeration date
12/13/2019
Last updated
12/13/2019
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