Individual
MS. AMY JOY BOULAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
407 VALLEY AVE NE APT U203, PUYALLUP, WA 98372-6940
(818) 720-0432
Mailing address
407 VALLEY AVE NE APT U203, PUYALLUP, WA 98372-6940
(818) 720-0432
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
60739343
WA
Other
Enumeration date
02/28/2017
Last updated
02/28/2017
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