Individual
ALISA RENAY WILLCOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 45TH ST S, FARGO, ND 58103-1189
(707) 616-7321
Mailing address
300 45TH ST S, FARGO, ND 58103-1189
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
91823047E49113
—
CA
Enumeration date
12/07/2021
Last updated
09/08/2023
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