Individual
ALEXIS ANN CUNNINGHAM-GLOSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4609 GRAPE RD STE D1B, MISHAWAKA, IN 46545-8259
(574) 217-1624
Mailing address
5779 GRAPE RD, PMB 171, MISHAWAKA, IN 46545
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-255438
IN
Other
Enumeration date
01/15/2025
Last updated
01/15/2025
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