Individual
GRACE ISLAND COOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
21485 RISKY RD APT 1, WAYNESVILLE, MO 65583-2529
(918) 907-4510
Mailing address
21485 RISKY RD APT 1, WAYNESVILLE, MO 65583-2529
(918) 907-4510
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/17/2021
Last updated
08/17/2021
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