Individual
GRACIE LAUREN MALICOAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19201 E VALLEY VIEW PKWY STE H, INDEPENDENCE, MO 64055-6913
(816) 474-3995
Mailing address
19201 E VALLEY VIEW PKWY STE H, INDEPENDENCE, MO 64055-6913
(816) 474-3995
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
OSDXPRLTS
MO
Other
Enumeration date
06/01/2023
Last updated
06/01/2023
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