Individual
TEAGAN ELISE BLACKSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3400 N WOODS LN, ROGERS, AR 72756-6712
(479) 636-3190
Mailing address
3400 N WOODS LN, ROGERS, AR 72756-6712
(479) 636-3190
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
06/11/2021
Last updated
07/24/2024
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