Individual
MADISON GROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
203 S. SANTA CLAUS LANE, NORTH POLE, AK 99705
(907) 521-0890
Mailing address
203 S. SANTA CLAUSE LN, NORTH POLE, AK 99705
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
RBT-18-71451
AK
Other
Enumeration date
11/27/2018
Last updated
11/27/2018
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