Individual
MICHELLE DAWN SUPPES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2813 25TH ST, GREAT BEND, KS 67530-7103
(785) 639-1304
Mailing address
6214 24TH AVE, BROOKLYN, NY 11204-3319
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/14/2023
Last updated
08/09/2023
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