Individual
ALLYSHA SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1804 CLOQUET AVE, CLOQUET, MN 55720-2141
(218) 600-5303
Mailing address
PO BOX 189, CLOQUET, MN 55720-0189
(218) 600-5303
(218) 879-2696
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/26/2025
Last updated
03/26/2025
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