Individual
NICOLE SIMONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
536 E KELLY AVE, JACKSON, WY 83001-8546
(720) 448-6227
Mailing address
PO BOX 11231, JACKSON, WY 83002-1231
(720) 448-6227
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
222Q00000X
Developmental Therapist
—
—
Other
Enumeration date
01/05/2016
Last updated
05/04/2017
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