Individual
DESTINY WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2217 E TUDOR RD STE 3, ANCHORAGE, AK 99507-1068
(907) 301-5471
Mailing address
PO BOX 771606, EAGLE RIVER, AK 99577-1606
(907) 301-5471
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/02/2018
Last updated
01/02/2018
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