Individual
TRISTAN SHEA VANDELAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 W SWANSON AVE, WASILLA, AK 99654-6844
(907) 357-0890
(907) 357-0891
Mailing address
PO BOX 873482, WASILLA, AK 99687-3482
(907) 414-9668
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/08/2020
Last updated
06/08/2020
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