Individual
KIA ISOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10506 GLOUCESTER LN, CHELTENHAM, MD 20623-1156
(301) 832-5742
Mailing address
10506 GLOUCESTER LN, CHELTENHAM, MD 20623-1156
(301) 832-5742
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/08/2023
Last updated
05/02/2023
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