Provider Demographics
NPI:1093226318
Name:LAW, CORI ERIN (MED, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:CORI
Middle Name:ERIN
Last Name:LAW
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1769 S PHEASANT DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-7714
Mailing Address - Country:US
Mailing Address - Phone:480-773-4511
Mailing Address - Fax:
Practice Address - Street 1:1769 S PHEASANT DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-7714
Practice Address - Country:US
Practice Address - Phone:480-773-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBA-0280103K00000X
CO1-17-25268103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst