Individual
MISTY DAWN ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
720 ORCHARD ST, ADA, OK 74820-2420
(580) 230-1413
Mailing address
720 ORCHARD ST, ADA, OK 74820
(580) 230-1413
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
11/29/2017
Last updated
11/29/2017
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