Individual
TAYLOR MARIE NIXON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
601 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(314) 251-6060
Mailing address
34166 GUN CLUB RD, BRIGHTON, IL 62012-3617
(618) 560-9139
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
19-92592
IL
Other
Enumeration date
02/26/2020
Last updated
02/26/2020
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