Individual
GWEN MICCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., BCBA, LBA
Contact information
Practice address
1255 W BASELINE RD STE 138B, MESA, AZ 85202-5821
(602) 859-9692
Mailing address
4540 S RURAL RD APT C14, TEMPE, AZ 85282-7041
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BEH-000767
AZ
Other
Enumeration date
11/07/2022
Last updated
11/07/2022
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