Individual
MRS. LAQUETTA JOYCE HAIRSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6330 NW KELLY DR STE A, PARKVILLE, MO 64152-4027
(816) 469-5162
Mailing address
510 ELIZABETH ST, LEAVENWORTH, KS 66048-3920
(913) 980-9502
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/20/2019
Last updated
08/20/2019
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