Individual
ANNIKA FONTAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2305 BROADWAY ST STE AND010, BOULDER, CO 80304-4106
(720) 771-0852
Mailing address
2 ADAMS ST APT 1406, DENVER, CO 80206-5727
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-171897
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-21-171897
BACB
—
Enumeration date
06/17/2021
Last updated
06/17/2021
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