Individual
KACIE MASSAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1003 WYOMING AVE, FORTY FORT, PA 18704-4002
(570) 846-0455
Mailing address
1003 WYOMING AVE, FORTY FORT, PA 18704-4002
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BH004732
PA
Other
Enumeration date
01/08/2020
Last updated
01/08/2020
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