Individual
GRACE NICOLE NAMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4152 30TH AVE S, FARGO, ND 58104-8524
(320) 424-9779
Mailing address
3108 5TH ST S APT.21, MOORHEAD, MN 56560
(320) 424-9779
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/03/2021
Last updated
06/03/2021
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