Individual
SAMANTHA DEEANN DORTCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4440 VIKING DR STE 400, BOSSIER CITY, LA 71111-7511
(318) 245-4113
Mailing address
PO BOX 1823, WEST MONROE, LA 71294-1823
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-17-45563
LA
Other
Enumeration date
07/31/2019
Last updated
07/31/2019
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