Individual
ALEXIS MARIE CHIDESTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1028 E WORTHY ST, GONZALES, LA 70737-4367
(504) 399-9851
Mailing address
1028 E WORTHY ST, GONZALES, LA 70737-4367
(504) 399-9851
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
012530305
LA
Other
Enumeration date
05/04/2023
Last updated
05/04/2023
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