Individual
MS. ALYSON MICHELLE GROOMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
600 LAKE HOLLINGSWORTH DR, LAKELAND, FL 33803-2364
(863) 665-7300
Mailing address
PO BOX 93374, LAKELAND, FL 33804-3374
(863) 665-7300
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019102000
—
FL
Enumeration date
05/09/2019
Last updated
05/25/2022
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