Individual
NICOLE MARIE LAVIGNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
425 BROADWAY ST, PADUCAH, KY 42001-0713
(270) 442-1452
Mailing address
425 BROADWAY ST, PADUCAH, KY 42001-0713
(270) 442-1452
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/06/2019
Last updated
05/06/2019
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