Individual
LAURA SUSAN SOUTHWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4000 SAN ERNESTO AVE, ANCHORAGE, AK 99508-2874
(907) 729-5020
Mailing address
4000 SAN ERNESTO AVE, ANCHORAGE, AK 99508-2874
(907) 729-5020
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/16/2019
Last updated
05/16/2019
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