Individual
AUTUMN SPANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
210 ASPEN ST, URIE, WY 82937
(307) 747-3005
Mailing address
210 ASPEN ST, URIE, WY 82937
(307) 747-3005
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-18-68301
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-18-68301
BCAB
WY
Enumeration date
10/31/2018
Last updated
10/31/2018
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