Individual
KIMBERLEE HAYCOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1417 CACTUS ST, WENDOVER, NV 89883-3030
(775) 934-2745
Mailing address
PO BOX 3848, 1417 CACTU ST, WENDOVER, NV 89883-3848
(775) 934-2745
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-16-13110
NV
Other
Enumeration date
03/23/2017
Last updated
03/23/2017
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