Individual
KATELYN MARISSA MALCORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, BCBA
Contact information
Practice address
9120 SPRINGBROOK DR NW, COON RAPIDS, MN 55433-5845
(952) 767-7222
Mailing address
9120 SPRINGBROOK DR NW, COON RAPIDS, MN 55433-5845
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-23-68595
MN
106S00000X
Behavior Technician
—
—
Other
Enumeration date
03/07/2019
Last updated
10/11/2023
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