Individual
DEQO MIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
706 ROBERT ST S, SAINT PAUL, MN 55107-2948
(952) 393-7939
Mailing address
706 ROBERT ST S, SAINT PAUL, MN 55107-2948
(952) 393-7939
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/23/2022
Last updated
06/23/2022
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