Individual
ALYSSA ADELINE MATTHEWS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6330 NW KELLY DR STE A, PARKVILLE, MO 64152-4027
(816) 569-5162
Mailing address
28200 SNIPE RD, RICHLAND, MO 65556-7455
(708) 897-5438
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
19-87077
IL
Other
Enumeration date
09/28/2019
Last updated
09/28/2019
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