Individual
EMILY JO WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
205 PORTLAND ST, COLUMBIA, MO 65201-6521
(573) 884-6082
Mailing address
205 PORTLAND ST, COLUMBIA, MO 65201-6521
(573) 884-6082
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-83406
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
900294051
—
MO
Enumeration date
07/16/2019
Last updated
07/16/2019
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