Individual
ALIA NICHELLE TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4916 108TH ST SW, LAKEWOOD, WA 98499-5615
(253) 861-6128
Mailing address
4916 108TH STREET SOUTHWEST, 14, LAKEWOOD, WA 98499-8703
(253) 861-6128
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/20/2017
Last updated
11/20/2017
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