Individual
JUSTIN BORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 W SWANSON AVE, WASILLA, AK 99654
(907) 521-0890
Mailing address
300 W SWANSON AVE, WASILLA, AK 99654-6844
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-18-60351
AK
Other
Enumeration date
07/18/2018
Last updated
07/19/2018
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