Individual
AVALON SIDNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3007 HARBOR LN N STE 1200, PLYMOUTH, MN 55447-5103
(612) 439-5650
Mailing address
11715 CHAMPLIN DR APT 308, CHAMPLIN, MN 55316-2386
(612) 702-8849
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
MN
Other
Enumeration date
05/06/2022
Last updated
05/06/2022
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