Individual
THALIA A GRUNDSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
396 GRIFFIN RD, BANGOR, ME 04401-3006
(207) 930-8129
Mailing address
760 UNION ST STE A, BANGOR, ME 04401-3125
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-20-46683
NH
Other
Enumeration date
01/28/2022
Last updated
01/28/2022
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