Individual
DOMINIQUE LYNN BASTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1824 8TH ST, LAKE CHARLES, LA 70601-6512
(719) 822-3103
Mailing address
1824 8TH ST, LAKE CHARLES, LA 70601-6512
(719) 822-3103
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
09/16/2019
Last updated
09/16/2019
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