Individual
GISELE LUCETTE MYRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1716 CORPORATE XING STE 3, O FALLON, IL 62269-3734
(844) 244-1818
Mailing address
1607 DYESS CT, SCOTT AIR FORCE BASE, IL 62225-6330
(717) 350-5850
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/28/2021
Last updated
10/28/2021
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