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Individual
KELLY JANNEA MANTZ
Active
Individual
KELLY JANNEA MANTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
CB61450960
WA
Other
Enumeration date
04/17/2023
Last updated
05/09/2024
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