Individual
LANE GAUDIOSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1403 TANGUY RD, GLEN MILLS, PA 19342-1654
(610) 389-4444
Mailing address
1403 TANGUY RD, GLEN MILLS, PA 19342-1654
(610) 389-4444
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB677388
PA
Other
Enumeration date
11/05/2021
Last updated
11/05/2021
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