Individual
MADISON MISTICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1250 SW RAILROAD AVE STE 130, HAMMOND, LA 70403-5013
(985) 500-3240
Mailing address
21600 OXNARD ST STE 1800, WOODLAND HILLS, CA 91367-7807
(818) 345-2345
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
LA
Other
Enumeration date
07/10/2019
Last updated
07/10/2019
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