Individual
MAKENNA MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
40 CAMELOT DR, FOND DU LAC, WI 54935-8049
(920) 907-3928
Mailing address
371 E 1ST ST, FOND DU LAC, WI 54935-4563
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
RBT-19-88334
WI
Other
Enumeration date
06/05/2019
Last updated
06/05/2019
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