Individual
JESSICA ADEL LAVELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4602 E UNIVERSITY DR STE 130, PHOENIX, AZ 85034-7430
(888) 754-0398
Mailing address
14682 N 174TH LN, SURPRISE, AZ 85388-7875
(425) 314-2632
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-137685
AZ
Other
Enumeration date
08/24/2021
Last updated
08/24/2021
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