Individual
PHOEBE PRISCILLA SULISTIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6125 UNIVERSITY DR NW STE B22, HUNTSVILLE, AL 35806-1765
(256) 692-9262
Mailing address
415 N RICHARD JACKSON BLVD, PANAMA CITY, FL 32407-3664
(850) 866-0441
(850) 254-0827
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-183500
AL
Other
Enumeration date
09/27/2021
Last updated
09/27/2021
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