Individual
CODI MIZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1919 ADAMS AVE, BUTTE, MT 59701-5617
(979) 224-5862
Mailing address
1919 ADAMS AVE, BUTTE, MT 59701-5617
(979) 224-5862
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/25/2023
Last updated
04/25/2023
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