Individual
AUTUMN GRACE MCCUIEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1148 STANFORD AVE, MEDFORD, OR 97504-8924
(949) 300-0785
Mailing address
1148 STANFORD AVE, MEDFORD, OR 97504-8924
(949) 300-0785
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
M250074288891
MI
Other
Enumeration date
05/18/2018
Last updated
05/18/2018
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