Individual
PENELOPE VICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPH, LBS
Contact information
Practice address
225 CHURCH ST, INDIANA, PA 15701-2124
(646) 479-6154
Mailing address
225 CHURCH ST, INDIANA, PA 15701-2124
(646) 479-6154
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BH005463
PA
Other
Enumeration date
09/13/2021
Last updated
09/13/2021
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