Individual
ALYSSA ANN STAFFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6836 ISAAC'S ORCHARD RD, SPRINGDALE, AR 72762
(479) 927-4100
(479) 927-4101
Mailing address
6836 ISAAC'S ORCHARD RD, SPRINGDALE, AR 72762
(479) 927-4100
(479) 927-4101
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
262527706
—
AR
Enumeration date
04/22/2021
Last updated
04/22/2021
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