Individual
DIVON L DAVIS-BODDIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
18330 N 79TH AVE, GLENDALE, AZ 85308-8343
(907) 378-0463
Mailing address
18330 N 79TH AVE, GLENDALE, AZ 85308-8343
(907) 378-0463
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
7560699
AK
Other
Enumeration date
04/04/2024
Last updated
04/04/2024
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