Individual
EYASU ASSEFA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
451 21ST AVE STE B, LONGMONT, CO 80501-1483
(800) 656-2376
Mailing address
451 21ST AVE STE B, LONGMONT, CO 80501-1483
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/15/2022
Last updated
12/29/2023
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