Individual
SERENA GRIJALVA OUTHIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7200 E JIM COTTRELL CIRCLE, PALMER, AK 99654
(907) 841-5757
Mailing address
7200 EAST JIM COTTRELL CIRCLE, PALMER, AK 99645
(907) 841-5757
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-18-56584
AK
Other
Enumeration date
06/01/2018
Last updated
06/01/2018
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