Individual
COURTNEY JEAN FATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1470 INDUSTRIAL DR NW, ROCHESTER, MN 55901-0700
(507) 353-3023
Mailing address
1470 INDUSTRIAL DR NW, ROCHESTER, MN 55901-0700
(507) 353-3023
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588993091
—
MN
Enumeration date
02/15/2021
Last updated
02/15/2021
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