Individual
MARISA LUELLAMAE SHACKLEFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
218 CENTRAL AVE N, FARIBAULT, MN 55021-5278
(507) 491-5475
Mailing address
218 CENTRAL AVE N, FARIBAULT, MN 55021-5278
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
06/12/2022
Last updated
06/12/2022
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