Individual
DESIREE ROA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10817 206TH ST E, GRAHAM, WA 98338-8841
(406) 249-6412
Mailing address
15724 118TH AVENUE CT E, PUYALLUP, WA 98374-9738
(425) 535-8587
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
CB61435604
WA
Other
Enumeration date
09/07/2023
Last updated
09/07/2023
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