Individual
LAURYN JADE BUCKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3155 N COLLEGE AVE, FAYETTEVILLE, AR 72703-3506
(479) 957-9121
Mailing address
3155 N COLLEGE AVE, FAYETTEVILLE, AR 72703-3506
(479) 957-9121
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-219679
TX
Other
Enumeration date
07/11/2022
Last updated
07/11/2022
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