Individual
LAKEN CRAIG ALLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
30 E LITTLE AVE, DRIGGS, ID 83422-5138
(307) 257-5487
Mailing address
PO BOX 11231, JACKSON, WY 83002-1231
(804) 614-5853
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-87844
ID
Other
Enumeration date
05/27/2019
Last updated
05/27/2019
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