Individual
KERISHA SOUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
3568 GERAGHTY AVE, FAIRBANKS, AK 99709-4701
(907) 374-7001
(907) 374-7008
Mailing address
3568 GERAGHTY AVE, FAIRBANKS, AK 99709-4701
(907) 374-7001
(907) 374-7008
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-17-39658
—
Other
Enumeration date
02/07/2018
Last updated
02/07/2018
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