Individual
XIAOYAN FANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
205 PORTLAND ST, COLUMBIA, MO 65201-6521
(573) 884-6052
Mailing address
205 PORTLAND ST, COLUMBIA, MO 65201-6521
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-17-40379
MO
Other
Enumeration date
09/25/2018
Last updated
09/25/2018
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