Individual
MRS. LINDA MARIE DIVINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2407 S CAMPBELL AVE, SPRINGFIELD, MO 65807-2903
(417) 551-9696
Mailing address
2407 S CAMPBELL AVE, SPRINGFIELD, MO 65807-2903
(417) 551-9696
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-102806
MO
Other
Enumeration date
12/31/2019
Last updated
11/27/2023
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