Individual
JUDY SEVILLANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15489 DEDEAUX RD, GULFPORT, MS 39503-2667
(228) 357-5671
(228) 357-5708
Mailing address
15489 DEDEAUX RD, GULFPORT, MS 39503-2667
(228) 357-5671
(228) 357-5708
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-15-11100
MS
Other
Enumeration date
06/14/2021
Last updated
06/14/2021
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