Individual
MISTY MINNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
120 ALPINE DR, GILLETTE, WY 82718-8844
(877) 584-6227
Mailing address
120 ALPINE DR, GILLETTE, WY 82718-8844
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-319362
CO
Other
Enumeration date
01/03/2024
Last updated
01/03/2024
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