Individual
TAKWA S GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
930 SPARKS ST N, TWIN FALLS, ID 83301-3688
(510) 283-7216
Mailing address
930 SPARKS ST N, TWIN FALLS, ID 83301-3688
(510) 283-7216
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/26/2024
Last updated
08/26/2024
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